
Class "R T~6 1 


Rnnlc ,F & 9 


Copyright^ 


COPYRIGHT DEPOSIT. 



IN FOUR VOLUMES ^ ^ ^ ILLUSTRATED WITH 
FRONTISPIECES IN COLOR BY W. T. SMEDLEY 



'^TEW and original treatises on the building, furnishing, 
and keeping a home ; on home etiquette, and the con- 
duct of dinner parties, receptions, weddings, etc.; on food 
economy and the preparation of both plain and fancy dishes ; 
on the care of the sick, the hygiene of motherhood, the 
treatment of infants and young children; on the legal rights 
of women in the various States of the Union, with advice as 
to business careers, investments, etc. ; and on the manly and 
ladylike conduct of young people during the formative period 
of character. With many illustrations in half-tone. 



I. THE HOMEMAKER (including Home Etiquette). 
By Carlotta Norton Smith, late Editor of The 
Art Interchange. 

II. THE HOME COOK BOOK. Practical Receipts by 
Expert Cooks. 

III. HOME NURSING — MOTHERHOOD— THE 

CARE OF CHILDREN. By Harriet Forbes 
and Harriet Merrill Johnson, Graduate Nurses 
of General and Maternity Hospitals. 

IV. AMERICAN WOMEN'S LEGAL STATUS. By 

George James Bayles, Ph.D., Lecturer in the School 
of Political Science, Columbia University. 

LETTERS TO AMERICAN GIRLS. By Sallie 
Joy White. 

LETTERS TO AMERICAN BOYS. By Professor 
William Herbert Carruth, of the University of 
Kansas. 




THE NEWCOMER 



— Home Nursing 



Home Nursing 

Motherhood— Care of Children 

BY 

HARRIET FORBES 

AND " 

HARRIET MERRILL JOHNSON 

Graduate Nurses of the Massachusetts Homeopathic Hospital, Boston, and the Sloane 

Maternity Hospital, New York ; Graduates of the Hospital Economics 

Course, Teachers' College, Columbia University ; and Visiting 

Nurses of Nurses' Settlement and Hartley House 



WITH FRONTISPIECE IN COLOR 
BY W. T. S MED LEY . 



"When one comes to look upon health as simply a mark of intelligence, 
as a private duty and a public duty, as indeed an essential part of the 
moral life, and when one comes to regard illness as an immoral and quite 
unpermissible thing, he has taken an important step in the process of 
education." — Charles Hanford Henderson. 




NEW YORK 

P. F. COLLIER & SON 

1905 



LIBRARY of CONGRESS 
fwo Copies rtWBiveo 

MAY 22 iy05 

Goyyngiu entry 
QU\SS</CZ XXc. Noi j 
COPY 6. i 



Copyright, 1905, by 
P. F. COLLIER & SON 



u\ 



^ 



CONTENTS 



PART I.— HOME NURSING 

I.— MATERIAL AND SPIRITUAL EQUIPMENT OF THE 
HOME NURSE 

Ethics of Nursing — What Room Should be Chosen — Care in Ventilation — De- 
vices for Ventilation — Freeing the Invalid from Noise — Simple Furnish- 
ings in Sick Room?— Bedsteads — Mattresses — To Make a Sick Bed — 
Daily Care of Sick Room — Care of Utensils — How to Save Steps . . 7 

II.— GENERAL CARE OF BED PATIENTS 

Structure and Function of Skin — The Cold Bath— Frequency of Bathing in 
Sickness — The Bed-Bath — The Foot-Bath — Care of the Hair — Care of the 
Mouth — Changing Sheets for Bed Patients — Changing Night-Dress — Pre- 
vention of Bed-Sores — Lifting and Moving Patients — Mechanical Appli- 
ances ............. 23 

III.— ENEMATA, SUPPOSITORIES, AND DOUCHES 

Administration — The Laxative Enema — The Purgative Enema — The Nutritive 
Enema — The Starch Enema — The Turpentine Enema — Rectal Irrigation — 
Suppositories — Douches — Gargles, Sprays, and Inhalations — Care of Uten- 
sils ............. 42 

IV.— OBSERVATION OF SYMPTOMS 

Circulation — How to Take Pulse — Temperature — Use of Clinical Thermometer 

— Respiration — Observation of Symptoms . . . . . -55 

V.— INFLAMMATION, EXTERNAL APPLICATION, 
MEDICINES 

Inflammation — Treatment — Dry Heat — Hot-Water Bags — Moist Heat — How to 
Make a Poultice — Fomentations — Cold Applications — Ice Coils — Counter- 
irritants — Massage — The Giving of Medicine — Hypodermic Injections — 
Care of Medicines ........... 69 

VI.— CARE OF OPERATIVE CASES 

Preparation for Operation — Emergency Preparation — Preparation of Patient — 
Full Preparation, for Operation — The Anaesthetic — Assisting the Surgeon — 
After-Care of Patient— The Problem of Food — Cases of Minor Surgery — 
Convalescence ........... 90 

VII.— ACCIDENTS AND EMERGENCIES 

Shock — Hemorrhage — Bleeding from Nose — Bleeding from Lungs — Fainting — 
Fractures — Dislocations — Contusions — Sprains — Chilblains — Frostbites — 
Toothache— Warts— Cuts — Burns and Scalds — Foreign Bodies — Sunstroke 
and Heat Exhaustion — Artificial Respiration— Insect Bites — Bites of 
Snakes and Rabid Animals — Poisons . . . . • • .no 

1 Vol. 3(1) 



2 CONTENTS 

VIII.— INFECTION AND CONTAGION 

Micro-Organisms and Disease — Transmission of Disease — The Protozoa — Dis- 
infectants — Methods of Disinfection — Typhoid Fever — Erysipelas — Mala-' 
rial Fever — Dysentery . . . . . . . . . .131 

IX.— INFECTIOUS DISEASES (CONTINUED) 

Influenza — Pneumonia — Tuberculosis — Forms of the Disease — Heredity — Chan- 
nels of Infection — General Precautions — Special Precautions for Attend- 
ants — Exercises Beneficial to Those with Tendency to Tuberculosis — Sug- 
gestions for Patients — Care of Patients — Cerebro-Spinal Meningitis . 150 

X.— ACUTE AND NERVOUS DISEASES 

Rheumatism — Tonsilitis — Bronchitis — Pleurisy — Appendicitis — Bright's Disease 

— Neurasthenia — Hysteria — Epilepsy — Insanity . . . . . .166 



PART II.— MOTHERHOOD 

I.— THE PHYSIOLOGY AND HYGIENE OF PREGNANCY 

Indications of Pregnancy — Quickening — Dress — Need of Fresh Air — Exercise 

— Food — Bathing — Sleep and Rest — Heredity . . . . . .185 

II.— AILMENTS OF PREGNANCY 

Nausea — Constipation — Increased Salivation — Varicose Veins and Hemorrhoids 
— Decay of Teeth — Palpitationi — Sciatica — Pruritus — Irritation of Bladder 
— Abdominal Bandage — The Physician — Midwives — Advice of Friends — 

* Receipts for Special Diet ......... 201 

III.— PREPARATIONS FOR CONFINEMENT 

Preparations for the Mother — Baby's Wardrobe — List of Clothes — The Nurs- 
ery Furnishings . . . . . . . . . . .218 

IV— LABOR 

Duration of Pregnancy— Preparations for Confinement — Stages of Labor — Con- 
tractions of the Uterus — Emergencies — After-Treatment of Mother — After- 
Treatment of Baby .......... 234 

V— AFTER-CARE OF MOTHER AND CHILD 

Rest — Dressings — Breasts — Diet — The Baby's Bath — The Cord-Dressing — Order 
of Dressing — Care of Eyes, Nose, Mouth, and Breast — Tub Baths — The 
Band — Feeding . . . . . . . . . . 245 

VI.— ABORTION AND PREMATURE BIRTH 

Abortion — Premature Birth — Care of Premature Baby — Gavage and Lavage — 

Suppressing Milk — Milk-Leg — Inexorable Laws of Nature . . . 262 

VII.— HABITS AND METHODS OF TRAINING 

Law of Habit — Unwise Training — The Day's Routine — The Baby's Laundry — 

Details of Bath — Naps — The Outing 276 



LIST OF ILLUSTRATIONS 



PART III.— CARE OF CHILDREN 

L— INFANT FEEDING 

Mother's Milk — Weaning — Cow's Milk — Modification of Milk — Prepared Foods 

— Points to be Noted — Schedule for Feeding — Household Measures . . 293 

II— DIETARIES 

Digestion — Needs of the Child — Diet Lists from Eleven Months to Three 
Years and a Half — Sweets for Children — Family Breakfast — Family Din- 
ner—Supper—The Child at Table 310 

III.— SCHOOL CHILDREN— THEIR FOOD AND EXERCISE 

Breakfasts — Luncheons — Physical Activities and Mental Development — Health 

and Education ........... 323 

* IV.— POINTS ON HYGIENE 

"Toughening" — Baths — The Teeth — Footwear — Dress ..... 336 

V.— DISORDERS OF CHILDREN 

Symptoms of Illness — Colic — Jaundice — Inflammation of the Eyes — Thrush — 
Diarrhoea — Constipation — Convulsions — Teething — Milk Crust — Eruptive 
Disorders — Hives — Prickly Heat — Ringworm — Croup — Rickets — St. Vitus's 
Dance ............. 349 

VI.— CONTAGIOUS DISEASES 

Mumps — Whooping-Cough — Measles — Chicken-Pox — Scarlet Fever — Necessary 
Precautions in Contagious Diseases — Scarlet Fever is Infectious — Diph- 
theria ............. 368 

VII.— PROBLEMS OF PUBERTY 

Development of the Child — Puberty — Instruction to the Child — Masturbation 

— Menstruation — Bathing During Menstruation . . . . .381 



LIST OF ILLUSTRATIONS 



Glass Sputum Mug with Metal Cover 

Metal Frame . 

Paper Filler . 

Invalid's Drinking Cup 

Woven Wire Mat . 

A Nursery Ice-Chest 

Water Cooler 

A Rubber Ring 

Horseshoe Air-Cushion 

Canvas and Wood Bed-Rest 



19 
19 
19 
ro 

23 

21 

21 

34 
34 
38 



LIST OF ILLUSTRATIONS 



A Cradle to Lift the Clothes . 

The Iron Standard Bed Table 

The Wooden Leaf Bed Table 

Trabaud Back Protector on Douche Pan 

A Fountain Syringe 

Hard Rubber Syringe 

Rectal Tube with Return Flow 

Douche Pan . 

Glass Nozzle . 

A Clinical Thermometer 

Hot-Water Bag 

A Stupe Wringer . 

Rubber Ice-Bags . 

Hypodermic Syringe of Glass and Asbestos 

Room Hastily Prepared for Operation . 

A Nightingale 

Pocket Sputum Flask 

Abdominal Bandage 

A Meat Press 

"Eureka" Bed-Pan . 

"Perfection" Bed- Pan 

Baby's Band . 

Baby's Shirt . 

Band 

Skirt 

Petticoat 

Dress 

White Enamel Bath-Tub for Baby 

Rubber Tub .... 

The Flannel Petticoat and Dress 

Slipping on the Flannel Petticoat and Dress 

Placing Baby in the Bath 

Feeder for Premature Baby 

The Murphy Bandage . 

Bath Under the Blanket 

"Hygeia" Nursing Bottle 

A Graduated Glass 

Stomach of Infant Five Days Old (Natural S 

Glass Cylinder Showing the Capacity of the 



ize) 
Stomach 



PART I 
HOME NURSING 



MATERIAL AND SPIRITUAL EQUIPMENT OF 
THE HOME NURSE 

Ethics of Nursing— What Room Should be Chosen— Care in Ventilation- 
Devices for Ventilation — Freeing the Invalid from Noise — Simple 
Furnishings in Sick Room — Bedsteads — Mattresses — To Make a Sick 
Bed — Daily Care of Sick Room — Care of Utensils — How to Save 
Steps 

THE thought of accepting an invalid as a member 
of the household is always a trying one, and often 
brings consternation into otherwise quiet homes. Possi- 
bly a few suggestions may lighten the burden of such a 
situation, and encourage the mother, sister, or wife who 
is to act the part of nurse pro tern, and who needs to 
know something of the equipment, both material and 
spiritual, for such an undertaking. 

The clean gingham dress of the hospital nurse, 
worn both winter and summer, is a familiar sight, and Dress of 
typifies that absolute cleanliness w 7 hich is both her i n g nurse 
personal and her professional characteristic. It is 
quite possible for the acting nurse also to don a cot- 
ton gown, which should be simple and easily laundered. 
Having once felt the comfort of such a working-dress 
she will hardly wish to return to the heavy woolen 
skirts so unsuitable for the sick-room. 

We all recognize the absurdity of a nurse's going, 
as one once did, to take charge of a case and appear- 
ing before her patient arrayed in a pink silk waist, yet 
the same incongruity would not appear so great if one 
of the family, or a familiar friend who was serving in 
the capacity of nurse, were the offender. The prin- 
ciple, however, is quite the same in either case. 

(7) 



8 HOME NURSING 

But far more important even than the matter of 
The f dress and quite within the possibility of every one, is 
care of the need of frequent bathing on the part of the nurse 
perso™ anc * proper attention to neatness in the details of her 
toilet — the clean, well-trimmed nails and hair care- 
fully and simply arranged. 

Deft hands, quick insight, a gentle bearing, good 
Blessed temper and a generous dash of humor are priceless 

cli3.r3.ctci"" 

istics in a blessings in a sick-room, and may be cultivated in a 
sick-room vef y j ar g e measurej if their value is sufficiently appre- 
ciated. The nurse who pounds the pillow on the pa- 
tient's bed or clumsily jars it every time she passes, 
who is ill-natured and unkempt, or who reveals by her 
manner that her work is arduous, is distinctly work- 
ing against the recovery of her patient, though she 
may little realize the cost of her thoughtlessness. 

ETHICS OF NURSING 

It is no time when a person is sick to regale him 
The Gold- with grewsome or unpleasant tales; yet how often a 
en ue garrulous neighbor delights in the opportunity of set- 
ting forth some harrowing incident while, it may be, 
the distressed patient is too weak even to protest. The 
ethics of nursing is a large subject, but perhaps, after 
all, the practice of the Golden Rule is its simplest ex- 
pression. 

CHOICE OF A ROOM 

As regards the chief features of importance in the 

selection of a sick-room, namely, the securing of good 

air, quiet, and plenty of sunshine, we must recognize 

The room that there are many households where these conditions 

best 

adapted- can not be ideal. But wherever a choice is possible, the 
vaiid'T use room best adapted for an invalid's use should be se- 
lected even at the cost of some inconvenience to other 



EQUIPMENT OF THE NURSE 9 

members of the family, since comfortable and hy- 
gienic surroundings are a large factor in the recovery 
of a patient, and model conditions will be described, 
because the ideal must always be the standard toward 
which we progress. 

An airy, spacious room, having a southern expos- 
ure and several windows, so that the sunlight can Having 
flood daily, and far enough removed from the noise conditions 
of the kitchen or front door to secure absolute quiet, 
affords the best possible conditions for a very ill pa- 
tient. 

VENTILATION 

If once we heartily believed the truth that the body 
starves for lack of oxygen as it plainly does for lack 
of food, there would be no necessity for the protest 
against tightly closed and ill-ventilated rooms. The 
starvation for oxygen, it is true, is much more slow, 
and it may be years before one sees evidence of the 
depletion the body is undergoing in cases where the 
supply is insufficient, whereas the daily demand for 
food is a crying one that can not be overlooked. 

In spite of our ignorant efforts to keep out the fresh The body's 
air, enough oxygen sifts in through the cracks of oxygen 
doors and windows to satisfy, in a small measure, the 
demands of the body, and thus relieve the feeling of 
suffocation which is the most urgent call of the or- 
ganism to supply its need. If this were not so, the suf- 
fering would be such that one could not tolerate the 

conditions. As proof of the impoverishment that ex- Proof of 

1 1 1 ,. • 11 -11 thls need 

ists under bad conditions, one has only to .cite the phys- 
ical effects upon the system observed after a night 
spent in a closed room — the dull head, lack of appetite, 
lassitude, and general depression — and compare this, if 
one has ever experienced it, with the feeling of ex- 



10 HOME NURSING 

uberance and delight in nature felt after a night spent 
in the open air. It is when disease comes, hcwever, 
in sick- that the real difference between the well and the ill- 
nourished body is most apparent. Not infrequently 
people who have never known sickness, but who have 
all their lives disregarded the laws of health in re- 
spect to ventilation and whose bodies have lived on a 
meagre supply of oxygen, are not able to resist the 
approach of disease. 

For the sick-room, low windows admitting an abun- 
dance of fresh air and sunshine are much needed, while 
the addition of a balcony opening out provides attrac- 
tively for the convalescent days, both in summer and 
winter. 
Open win- Window-boxes help to make the chamber cheerful, 
in^iid° r and are in no way objectionable; but plants filling a 
side boxes wni dow and shutting out the sunshine should be con- 
for plants demned. 

If the window is arranged to lower from the top — 
and all windows should properly be so arranged, since 
the foul air of a room has a tendency to rise — venti- 
lation in cold weather is made easy. By reversing the 
position of the sashes, a current of air escapes in the 
centre between the unevenly fitting framework. But 
Good better still for use in the winter, is a board four or five 
of et ve°n- S inches wide and perhaps an inch thick, just long 
tiiation enough to fit the window if slipped under the lower 
sash. This method provides a larger current of air in 
the centre between the sashes, and in either case there 
is no draught possible. Another device is to fasten a 
piece of cloth across the lower part of the window 
from side to side, so that the air can not blow directly 
into the room when the bottom sash is raised. 

The use of small screens will not be forgotten, and 
often one may be improvised by means of a clothes- 



EQUIPMENT OF THE NURSE 11 

horse and a couple of sheets or light shawls. A high- The use 

, , , , , , - of screens 

back chair may also serve the same purpose, and for 
a baby's crib an open umbrella does very well if noth- 
ing better is at hand to protect against the draught. 

A fireplace provides another means of ventilation 
besides adding greatly to the charm of the room. 

Ventilation is generally a possibility in any sick- 
room, but absolute quiet is not so easily secured, and 
on this account certain cases must be sent to the 
hospital. 

It must be borne in mind that when the doctor ad- 
vises the hospital it does not necessarily mean the des- what 
peration of the case, but very possibly that the in- a hospital 
creased facilities for the proper care of the patient imv ieb 
which the hospital affords are demanded in order to 
hasten recovery. 

NOISE 

There are some devices by means of which an in- 
valid may be spared the irritation of trifling noises 
and the sharp, sudden sounds always much more an- 
noying than the dull, continuous rumble of the street 
or the general stir about the household. A creaking 
door-hinge can be oiled, even if one has nothing but How to 
vaseline with which to do it, and on the door of the l^noiiel" 
sick-room, which must be frequently unlatched, a in horne 

- 1 J nursing 

small towel may be twisted from one handle to the 
other to prevent its closing tightly, or a rug be pulled 
across the threshold to serve the same purpose. 

Windows which rattle can be made secure by the 
aid of a few pegs whittled from burnt matches, and Devices 
should be attended to before the patient is settled for 
the night. If a dripping faucet can not be turned off, 
a cloth may be tied over it, and the loose, creaking 
boards in the floor may become such familiar spots 



12 HOME NURSING 

to the thoughtful nurse that she almost unconsciously 
avoids them. If a grate fire or stove is in the room, 
the care of it may be made far less trying to the 
nerves of the sick one if the coal is placed in a large 
paper and laid on the fire when replenishing it, in- 
stead of being shoveled in the usual way. A wooden 
poker can be substituted for an iron one, and large 
clinkers removed with the hand instead of turning 
them down with the ashes when a new fire is to be 
built. 

Whispering is always exasperating to a sick per- 
The tone son, and whatever conversation is necessary in the 
voice room or immediately outside the door should be 

carried on in low, quiet tones, but never in a stage 
whisper. One's manner of addressing a patient should 
be considerate, particularly if he is very ill. He 
should never be startled by loud or abrupt tones from 
behind, but having first gained his attention speak 
distinctly but with quiet voice. These suggestions 
Hints for are scarcely necessary to one who has had experience 
perienced with sick people, but to the uninitiated, particularly 
if she be young and vigorous, without "nerves" her- 
self, they may possibly be of value, as it is a most 
difficult thing to realize exactly how an ill person 
craves the relief from noise and confusion or appreci- 
ates any effort to minimize such for him. 



FURNISHINGS OF THE SICK-ROOM 

As to the furnishings of the sick-room, the 
No fumi- greatest simplicity is required both from the hygienic 
essentials and from the aesthetic standpoints. The sleeping- 
room, even in health, should be a place free from 
the unnecessary adornment of heavy hangings and 
Crowded bric-a-brac, gathering millions of microbes 



EQUIPMENT OF THE NURSE 13 

which elude the most careful housewife. If possible, 
let the walls be painted some neutral tint restful to 
the eye, so that they may be easily cleaned, and have 
no more furniture in the room than is absolutely 
necessary for use. A bed, table, easy-chair, lounge, 
and screen constitute the essential furniture. A hard- 
wood floor is best, but if it is necessary to carpet, 
straw matting is better than wool, and can be found 
in very attractive styles. Lightweight rugs that can 
be taken out and shaken every day may be used on 
the hardwood floor. 

A set-bowl in any bedroom is always objection- 
able, and is not to be tolerated if the modern method Avoid bad 
of open plumbing has not been adopted. The con- 
stant escape of poisonous gases by means of leaky 
traps is something that should be guarded against at 
all costs. But it is a simple matter, fortunately, to 
cover or plug up the escape holes, and water may be 
kept standing in the bowl if the bedroom is so 
equipped, though the better plan, of course, is to re- 
move all plumbing to an adjacent room not used for 
sleeping. 

The most suitable bedstead for a sick-room is 
readily admitted to be the single or three-quarter The bed 
size iron frame with double woven wire mattress and position 
having a height of two or two and a half feet. This 
frame painted white can be easily and thoroughly 
cleaned, and its height makes it convenient for lifting 
and moving a patient. It should stand in the room 
in such a position that the patient does not directly 
face the light from any window, and also so as to be 
easily accessible from both sides. 

In spite of the supposition that the feather bed Never a 
has been relegated to the garret- or made over into bed 
pillows, it is still necessary to emphasize the fact 



14 HOME NURSING 

that it is wholly unsuitable for an invalid's use. It 
is quite impossible to take proper care of a patient 
unless this is discarded. It retains the heat of the 
body, and if it becomes damp is an offence, if not 
a positive menace. It is also very difficult to 
lift a person from side to side as he lies in the 
hollow. 

The hair mattress is, of course, the most satis- 
factory bed, yet some patients complain of the tuft- 
ings, and it must be admitted that if the strings give 
way the hair may move and cause irregularities in 
the surface of the bed. The mattress manufactured 
Mattress by the American Interlaced Curled Hair Company 
tuftings of Philadelphia, Pa., is especially sanitary, and as the 
hair is in sheets it requires no tufting and is easily 
kept in order. The ticking can be slipped off and 
washed, and as the interior itself is very porous it is 
cooler and can be more easily cleansed and fumigated 
than any other mattress more compactly made. In 
The value cases of long illness a second bed is of great value, 
beds and by bringing both beds close together the patient 

can be drawn on a blanket or stout sheet from one 
mattress to the other and the mattress thoroughly 
aired on a balcony or in another room every day. 
A mattress turned once a day does not readily get 
out of shape, but in case it begins to sag, a light 
shawl or blanket folded not too thick can be placed 
under the centre to keep it level. 'Mattresses should 
Care occasionally be wiped over with a cloth wet in some 

mattress antiseptic solution and put out of doors to dry. A 
whisk-broom may be used instead of the cloth if pre- 
ferred and the mattress thoroughly sprinkled with 
the solution. 



EQUIPMENT OF THE NURSE 15 



PREPARATION OF A SICK-BED 

To prepare a sick-bed, place first a stout pad to 
cover the centre of the mattress, and over this, drawn Th f P a f 

' and under 

tightly and evenly, the bottom sheet, which should be sheet 
neatly tucked in at the corners. Next should always 
come a protector of some sort large enough to ex- 
tend from the edge of the pillow to within two feet 
of the bottom of the bed. This protector may be of 
black or white rubber, enamel cloth (which, however, 
cracks easily), or sheets of tar paper folded' between 
newspapers, if rubber is not obtainable or if the 
patient has serious objection to its use on account of 
its heat. In cases where there is no immediate cause _ 

The pro- 

for the rubber sheet it may be placed next to the tector and 
mattress, and thus serve to protect it in case of any 
accident occurring. 

The rubber sheet is to be covered by what is 
known in hospital phraseology as the "draw-sheet," 
an ordinary-sized sheet folded with two hems to- 
gether, though, if desired, a single piece of cotton 
of the width of the doubled sheet would answer the 
purpose quite well and be somewhat more easily 
laundered. This is put on so that the hemmed edges 
come at the bottom and the other edge high enough 
under the pillow to prevent the possibility of a rest- 
less patient getting the elbow under it. It should be 
tucked in at one edge evenly and then drawn as tight Care 
as possible from the other side, pulling always at the draw sheet 
centre first, and, after tucking that in, making smooth 
the rest of the side. In tucking in the draw-sheet 
with a patient in bed, this method of procedure is 
essential if the sheet is to be made tight. The patient, 
if able, should lift the hips slightly while the sheet 
is being tightened. 



16 HOME NURSING 

A draw-sheet properly put on ought to add much 
to a patient's comfort, as it ensures a smooth, firm 
surface underneath the back and it can be changed 
so easily that the patient need have no sense of 
fatigue while it is being done. 

The covering for the bed ought always to be light, 
Blankets but sufficiently warm, and the top sheet should fold 
than quilts over the edge of the blankets to keep them from 
becoming soiled. Blankets, or even lightweight 
shawls, if one is reduced to an extremity, are far 
better than bedquilts of any sort, and two light 
blankets are warmer than one very heavy one, be- 
cause of the layer of air between them which acts 
as an additional covering. The coverlet, if heavy, 
may be replaced by a sheet, though dimity is being 
sold now in place of the Marseilles or other heavier 
materials. At night it should be removed and folded 
neatly to keep it fresh for day use. In tucking 
in the clothes at the bottom of the bed, they ought 
not to be drawn tightly over a patient's toes, a fact 
which some nurses, overzealous for appearance, are 
apt to forget. In some cases where there is extreme 
Comfort nervousness or where the feet are particularly sensi- 
first P : at a p nt tive to any irritation, it is better not to have the 
pearance c i thes tucked in at all at the bottom. The comfort 

second 

of the patient should never be sacrificed in order to 
gain a better appearance of the bed. 



DAILY CARE OF ROOM 

The daily care of the sick-room is most im- 
portant. The room should at all times present a tidy 
and restful appearance. If the weather is cold a 
light shawl may be thrown over the -patient's head 
and extra covering provided so that the apartment 



EQUIPMENT OF THE NURSE 17 

may be thoroughly aired. This should be done both 
night and morning for a few minutes, and in cases Frequent 
where the air becomes offensive it should be done 
several times during the day. 

If there is a carpet on the floor the surface dust 
can be removed by going over it lightly with a damp To clean 
cloth wound round a broom. No thorough sweeping ^ c * t r c 
should be attempted with the patient in the room. 
A damp dust-cloth is also to be used for the furni- 
ture, so that as little dust is stirred up as possible. 
Soiled dishes and remnants of food should never be 
allowed to stand in the room, but should be removed 
at once after the patient has eaten. Frequently he 
will insist that it does not matter, or will even object ness tX atid 
to tidiness, but there is an unconscious feeling of rest orderliness 
that is engendered through orderliness of which he is 
himself quite unaware, and this should not be denied 
him. A little tact or playful insistence will usually 
remedy any objection on his part. The same thing 
is true in regard to the serving of meals to a con- 
valescent or to some member of the family who is 
temporarily kept in bed and who thinks to save work 
by urging that he does not care how things are 
served. He may be quite honest in his feeling, and 
yet find that the dainty service tempts his appetite so 
that he is able to eat a far better meal than otherwise. 

The necessary medicines, mouth-wash, pitcher of 
water, and all the paraphernalia of the sick may 
stand on a small table or shelf, placed if possible out 
of sight of the patient, as it is pleasanter to have all 
the reminders of sickness removed. A clean towel 
on the table looks more suitable than an elaborate 
table-cover, and a fresh sheet of white wrapping- 
paper laid over that saves laundry and may be 
changed every day or two as necessary. 



18 HOME NURSING 

If the patient is able to be moved into another 

In case room there should be a weekly cleaning of the sick- 

cieaning y room, with thorough sweeping, cleaning of brasses, 

beating of mattress and airing of blankets, since 

fresh air has germ-destroying powers that may be 

utilized by every one. 

Large and small squares of cloth are needed for 
Of the various purposes about the sick-room, and can easily 
squared be. made and kept on hand for use when required, 
of cloth There should be several bed-pan covers, made of 
heavy cloth or doubled thicknesses of old sheeting, 
furnished with loops to hang by, and separate smaller 
cloths for wiping the bed-pan and the wash-bowl. It 
is convenient to have these latter of different size or 
of figured cotton, so that they can be readily dis- 
tinguished from each other. Pieces of old sheets or 
toweling can be cut into convenient sizes and hemmed 
to slip under the bed-pan when it is used, and a 
quantity of small pieces of old cotton torn into squares 
of about six inches will be found useful for the 
necessary bathing after the bed-pan has been used. 
Absorbent cotton can of course be used for the same 
purpose, but is more expensive. 

GARE OF UTENSILS 

The care of the utensils in use about the sick- 
room must not be overlooked. The utmost cleanli- 
ness is necessary in regard to them. Bed-pans and 
urinals should be rinsed each time after their use with 
cold water, and then washed with scalding water 
and soap and dried with a cloth kept for the purpose. 
A weekly scouring with sapolio is necessary if the 
use of the pan continues many weeks. Sputum mugs 
should be boiled every day for twenty minutes, and a 
small pan kept expressly for this use. 



EQUIPMENT OF THE NURSE 



19 



In preparing a mug for a tuberculosis or pneu- 
monia case one should be selected which is smoothlv Special 

11* T£. Care * °* 

glazed so that no germs may lodge in any crack. If sputum 
this is neatly lined with toilet-paper, letting the paper mug 
entirely cover the edge and fold down over the out- 




Glass Sputum Mug with Metal Cover 

side of the cup, the lining can be very easily lifted 
out and burned and a fresh lining made. It is best 
to have two mugs, so that one may be in use while 
the other is being sterilized. A very useful cover can 
be made by cutting out a piece of cardboard the size 





Metal Frame 



Paper Filler 



of the cup and putting a large safety-pin through the 
centre for a handle. 

Excellent appliances for the use of tuberculosis 
patients are made, consisting of a papier-mache form 
which is inserted in a covered metal holder. 



20 HOME NURSING 

In nursing cases of cancer, tuberculosis, typhoid 
Keep the fever or contagious diseases, care must be taken to 
dishes keep all dishes, knives, forks, and spoons used in the 

SCD3.r3.tG 

sick-room separate from those in general use. It is 
better to keep the sick-room dishes upstairs, and to 
have a small dishpan in some convenient place for 




Invalid's Drinking Cup 

washing them, so that they need not be sent to the 
kitchen, as errors are apt to occur and the dishes get 
mixed. They are best disinfected after they are no 
longer needed by boiling them for half an hour. 
There are a few things which, if conveniently ar- 

Littie con- ranged, can save many steps on the part of the nurse. 

foi m sav- es If a patient is on fluid diet, or it is necessary to heat 
water continually, it is always possible to have a 



vemences 
for sav- 
ing steps 




Woven Wire Mat 

saucepan and some device for heating liquids which 
may be kept in an adjacent room or in the halL Also 
a dishcloth and towel can be kept at hand so that the 
glass and saucepan may be washed as soon as used. 
A very simple arrangement for heating, if gas can be 
used, is by means of a woven wire mat which can 



EQUIPMENT OF THE NURSE 



21 



be bought for a few cents, and is intended to rest on 
the gas globe. This will hold quite a good-sized pan 
and heat its contents very quickly. 








A Nursery Ice-Chest 



A nursery ice-chest, which is a tin box with two 
or more compartments, is an ideal thing to hold the^st 6 
milk and foods that are being used constantly. A 




Water Cooler 



very good substitute can be planned for use in cool 
weather by having fastened outside the window a 
large uncovered soap-box, with the open side facing 



22 HOME NURSING 

the room. This can be protected by a piece of white 
enamel cloth tacked on to form a curtain over the 
front, and the whole thing can be kept sweet with 
soap and water. 

Food must never be allowed to stand in the ice- 
Milk and box till it becomes old, and milk and butter should 

butter . 

should nave a separate compartment if possible, as their 
ciai care flavor is very easily affected by strong-smelling foods. 
The ice-box should be looked over every day, and 
the shelves wiped with a damp cloth. Once a week 
there should be a thorough cleaning with washing 
soda and warm suds followed by careful drying in 
the sun if possible. 



II 



GENERAL CARE OF BED PATIENTS 

Structure and Function of Skin— The Cold Bath— Frequency of Bathing in 
Sickness— The Bed-Bath— The Foot-Bath— Care of the Hair— Care of 
the Mouth— Changing Sheets for Bed Patients— Changing Night-Dress— 
Prevention of Bed-Sores— Lifting and Moving Patients— Mechanical 
Appliances 

THE comfort of a sick person, whether he realizes 
it or not, depends upon clean surroundings, a 
clean body and the ease with which his wants are 
attended to. This ease is one of the gifts which ex- 
perience, particularly trained experience, gives. It 
means that the added burden sickness has brought is The gain 

•111-1 from absc- 

not made apparent to the patient, that the little wants lute rest 

of mind 

are met before they are realized, and that the re- and body 
sponsibility of medicines and nourishment is given 
over by him with a sense of relief; in short, that 
freedom from care and anxiety is made possible, and 
with it that absolute rest of body and mind which 
adds greatly to the chances of a speedy recovery. 

The subject of bathing and its importance, both 
in health and in sickness, is so familiar to the students 
of hygiene and lovers of good health, that we are apt 
to forget the great number of people who have little 
sympathy with what they consider the fads of 
would-be reformers. The ignorance of this great 
number about the necessary function of the skin and 
its delicate structure makes their proper care of the 
body very dull and perfunctory work, if indeed they 
do not actually neglect it. 

(23) 



24 



HOME NURSING 



a micro 
scope 



STRUCTURE AND FUNCTION OF THE SKIN 

The skin is in two layers. The upper or scarf 
skin is what is raised as a blister when one is burned, 

Scarf skin and this is constantly rubbing off in minute scales. 
We are generally unconscious of this, though we can 
easily recognize it in the dandruff and in the dried 
skin that we find on an arm or leg that is left for 
weeks in a bandage or splint. Although this scarf- 
skin is constantly being shed, it is as constantly being 
renewed from the second layer, called the true skin. 
This upper skin is not sensitive at all, while the under 
layer is supplied with blood-vessels and nerves. 

The two Under the microscope we see that these two layers 

layers or * J 

skin under f s ki n are composed of a multiplication of tiny bodies 
which are called cells, the upper ones being very flat 
and horny, while the lower ones are larger and ir- 
regular in outline. As the lower cells grow, they push 
up toward the top and become flattened, so that as 
scarf-skin they are the tiny scales we can see. This 
is going on constantly all over the body, whether or 
not we can detect it, and the principle is just the 
same as that which makes the swelling buds push ofT 
the old year's leaves. 

Another substance that is present on the skin at 
all times is perspiration, which is constantly being 
poured out from small glands found in the true skin. 
At an ordinary temperature, when we are in health, 
the amount of perspiration is insensible, but as we all 
know in certain diseases, or when the temperature is 
raised from any other cause, it is poured out in large 
quantities. 

The sweat is not wholly water. In health it con- 
tains some salt, and in diseases of the kidneys, when 
they do not perform their proper amount of work, it 



The per- 
spiration 



CARE OF BED PATIENTS 25 

also holds some of the waste matter of the bodv, What it 

contains 

which would otherwise be carried off in the urine. and accom 

phshes 

Sometimes in sickness a person can not be made 
to perspire sufficiently, and when by means of medi- 
cine and treatment we find the skin growing moist 
we regard it as a sign of returning health. By this 
we see that the elimination of water from the body 
through the pores of the skin is a very necessary 
process as a means of regulating the heat of the body, 
and that anything that interferes with the free action 
of these glands must be guarded against. 

The third substance that we find excreted on the 
skin is a sort of oil which is also contained in little Th ? lub r,i- 

cating oil 

glands. This serves to keep the skin soft and flexible, 
particularly to lubricate the hair and to keep it smooth 
and glossy and also to protect the body from mois- 
'ture, exactly as the oil enables the birds' feathers to 
shed water. The openings from these glands are 
larger in some parts of the body than in others. For 
instance, we find them very large and apparent about 
the nose, and when they become clogged with the 
secretions they are still more enlarged and form what 
we know as pimples. 

There also escapes from the skin some gases like 
what we exhale from the lungs, and it is capable, too, The skin's 
of absorbing small quantities of substances that may and ab- 
be rubbed upon it. It is for this reason that patients, powers 
particularly babies that are losing flesh, are rubbed with 
oil or milk, though this is not considered as important 
a function as it once was. 

To sum up then, we should say that the skin is 
protective — that it is a helper to the kidneys in getting what the 
rid of the waste of the bodv in the perspiration and in P r °- 

1 l tection 

to the lungs in getting rid of some of the carbonic 

acid gas ; that it absorbs to a limited extent substances 
2 Vol. 3 



26 HOME NURSING 

rubbed over the outside layer and very rapidly absorbs 
those injected beneath the upper, or scarf, skin; and 
that, finally, through the sweat glands, it is a power- 
ful regulator of the heat of the body. 

It is easy to feel the significance. of the bath as 
Conse- regards health and comfort in the face of these facts 

quent 

values of relating to the structure and function of the skin. All 

the bath & 

these glands are essential to our well-being. If they 
are clogged in any way we feel the results. On ac- 
count of the oil that is present the warm bath at least 
once a week is advisable. Plenty of soap, warm water, 
and a thorough drying afterward, taken at night, clears 
up the skin, relaxes the muscles, and makes the chances 
for restful sleep more sure. 

But it is the value of the daily cold sponge that 
we need to emphasize. 



THE COLD BATH OR SPONGE 

In our changing climate we are very liable to colds. 

?on y e Cold ^ we on *y realized what a safeguard the splashing 
cold sponge is there would be more willingness to over- 
come the first unpleasantness of the use of cold water 
in the winter. 

The first effect of the cold bath is to drive the 
blood from the surface, to reduce the temperature of 
the body and to retard the action of the heart. A 

its effects natura l reaction should take place under normal con- 
ditions, and the blood be sent to the surface of the 
body with a general quickening and stimulation of the 
circulatory and respiratory centres. If this reaction 
does not occur and if a feeling of pleasant, tingling 
warmth does not follow, the cold bath is not bene- 
ficial. 

If one accustoms the chest to the splash of cold 



CARE OF BED PATIENTS 27 

water followed by a vigorous rub which leaves the 
surface red and glowing, the resistance to cold is 
greatly increased. 

Another advantage in the daily bath is the fact 
that the body is exposed to the air at least once a dav. Value of 

J k ■* air on 

We keep our bodies so securely wrapped from the the skin 
air that draughts are dangerous and the ordinary 
change of passing from warm rooms to cool out-of- 
doors brings on colds. 

If for any reason the daily bath is impossible, a D bath 
brisk rub with a coarse towel or brush fulfils to a 
certain extent the same purpose. 

These facts which we emphasize as so important 
in health one can easily see are vastly more potent in 
sickness, for at such times the excretions of the skin 
arise from a diseased body. 

In most cases a daily warm sponge bath is of posi- 
tive benefit to a patient, though if there is extreme Daily 

- 1 ^ warm 

weakness the entire surface of the bodv should not be sponge 

benefits 

bathed at one time, and it may sometimes be better the patient 
to substitute for the soap and water bath an alcohol 
sponge, wiping off the surface of the body and re- 
freshing the patient without fatiguing him. 



FREQUENCY OF BATHING IN SICKNESS 

In ordinary cases of sickness, then, we may say 
that a daily bath is called for and very rarelv is there Guard 

1 r • • i • • • r r against 

any danger of injury to the patient arising from it if cfiiii and 
proper care is taken not to chill or to fatigue him. 
The windows should always be closed, and the room 
made sufficiently warm before beginning. 

Baths given in sickness are varied in kind and pur- 
pose, but it is seldom that anything other than the 
cleansing bath or alcohol sponge would be called for 



28 HOME NURSING 

in the home without the aid of a nurse especially 
trained to administer it. 

THE BED-BATH 

Before beginning a bed-bath everything required 
Have for use must be at hand — a basin, soap, hot and cold 

everything * x 

at hand water, slop- jar, face-cloths, towels, and clean linen — 
as it is annoying to a patient to be left in the midst 
of his bath while the nurse goes after some forgotten 
article, and it is evidence of poor management if this 
occurs. 

The patient is now to be placed between blankets, 
Snt be- an< ^ ^ e bedding removed. A very convenient plan 
blanket ^ two blankets are not available, and it is often 
and towei s j m pi er j n anv case, is to substitute for the under 
blanket a large Turkish towel which can be slipped 
under the different parts of the body as they are being 
bathed and thus protect the bed 'as a blanket would 
do. After a towel has become thoroughly damp it 
should be replaced by a fresh one. A sponge or 
flannel wash-cloth will retain the heat better than 
cotton. Only a small part of the body should be ex- 
posed at a time and that thoroughly washed and dried 
before going on. The water should be kept comfort- 
ably warm, and changed once during the bath. All 
fresh linen must be well aired and warmed before 
putting on the patient and careful attention given to 
the hair, mouth, and nails. 

THE FOOT-BATH 

A foot-bath in bed can be easily managed, and is 

The proc- sure to be refreshing to the patient, who lies on his 

foot-baVJf back with knees flexed and the top covers turned 

back over his body. The lower part of the mattress is 

then covered by a folded blanket, over which is laid a 



CARE OF BED PATIENTS 29 

towel. The foot-tub is placed on this, the feet gently 
lowered into the water, and the top blanket drawn 
back over the tub. After removing the bath the feet 
rest on the towel and must be left thoroughly dry and 
warm. 

THE CARE OF THE HAIR 

The combing of the hair is a detail of the toilet 
which most patients dread, yet this is quite unneces- 
sary if it is properly done. If arranged in two braids 
it is both comfortable and easily cared for, even if a Hair best 
person is very ill or can not lie easily on her side, and two braids 
it should never be allowed to become snarled or mat- 
ted. If it is braided closely once, or in case of unusual 
restlessness twice, a day, there will be no difficulty 
in keeping it free from snarls. It is surprising to find 
how many people do not realize the need of this daily 
care of a patient's hair, and having once neglected it 
during the critical part of an illness find it so matted 
that they are helpless, and perhaps have it cut when 
there is really no need. 

If the hair becomes matted it needs only to be 
wet with alcohol and left a few moments to dry, when Treatment 
the tangles can then be picked out lightly with the hair is 

r -r i «- • r • ^t m atted 

fingers if one has a sufficient amount of patience. No 
hair need ever be sacrificed if this method is remem- 
bered, though it may take many hours of labor at 
different intervals to remove all the snarls. In comb- 
ing, begin always at the ends of the hair, holding it 
firmly, but without exerting any tension on the scalp. 
If the hair has been wet with blood, as in the case of 
a scalp wound, the clots can be removed by the use 
of a solution of soda. 

A shampoo may be managed easily in the convales- 
cent days by placing the patient across the bed so that 



30 HOME NURSING 

the head pillow lies along the side. The pillow should 
Shampoo be protected by a rubber sheet and the hair washed 

for the . r , J 

convaies- m a basin placed on a low table or chair by the bed. 
A little alcohol rubbed afterward in the scalp will 
help to dry it quickly and prevent the patient from 
taking cold. If a cot bed is used it will not be neces- 
sary to change the patient's position, as the same thing 
can be done at the head of the cot. 

Sometimes one is confronted with the unfortunate 
in case problem of the best way of removing lice from the 
accident, hair. The routine practice recommended in the large 

of vermin * . ° 

schools of New York, where there is constant inspec- 
tion of the heads, is to wash the hair and scalp thor- 
oughly with kerosene and leave the head bound up 
in a towel overnight. The kerosene, though un- 
pleasant to use, has a good effect upon the hair and 
scalp. In the morning hot vinegar is applied to de- 
stroy the nits. This can be poured upon the hair, but 
since its effects are not specially beneficial it is better 
to dip a fine-tooth comb into the vinegar and to thor- 
oughly moisten the hair while it is being combed. The 
vinegar softens the gelatinous substance which at- 
taches the nits to the hair, so that tihey come off easily. 

Another treatment that is invariably effective is a 
thorough wetting of the scalp and hair with tincture 
of larkspur, which is left overnight in the same way. 
Iti is not necessary to follow this treatment with the 
vinegar. A second application may be demanded if it 
is found that the first has not been successful in de- 
stroying the nits. 

If children are in a public school where this 
And con- trouble is common it is much wiser not to keep the 

tammation 

at school hair very long, and absolute vigilance is necessary m 
order to make sure that the heads are perfectly free 
from vermin, as, once started, the nits appear very 



CARE OF BED PATIENTS 31 

rapidly. A neglected head means that eventually an 
eczematous eruption appears, which is due directly to 
the presence of the vermin. 

THE CARE OF THE MOUTH 

The care of the mouth during sickness must not 
be overlooked. If the patient is not too ill, the teeth Cleaning 

r m m , with brush 

should be brushed night and morning, but if that is or cotton 
impossible small squares of muslin or bits of absorbent 
cotton wet in a boracic acid or listerine solution may 
be used to wipe the tongue and gums. A mild solu- 
tion of boracic acid (half a teaspoon to a glass), or a 
few drops of tincture of myrrh in a glass of water, 
makes a good mouth-wash, and if a patient is on milk 
diet, it is necessary to wipe out the mouth frequently 
in order to keep it sweet and clean. 

In cases of pneumonia or typhoid fever, where the 
mouth and teeth accumulate an offensive and tenacious The sordes 

... °f pneu- 

substance known as sordes, it is necessary to use a monda and 
mouth-wash which will help to cut this substance and 
make it more easy of removal. Equal parts of lemon- 
juice, glycerine, peroxide of hydrogen, and water used 
freely both night and day will keep the mouth in as 
good condition as is possible. 

In such cases, as will be seen later on, the fingers 
should not be introduced into the mouth unless a rub- 
ber cot has first been put on, because of the danger of 
infection, and if a cot is used it should be kept in a 
solution of boracic acid or other harmless antiseptic. 
Swabs made of cotton wound round a toothpick can 
be used instead, and burned at once. 

CHANGING SHEETS FOR BED PATIENTS 

To change the sheets with a patient in bed, it is 
necessary first to fold the fresh draw-sheet and lay it 



32 HOME NURSING 

in large plaits ready to slip under the patient. He is 
turned on the side most easy for him, the bedding 
loosened, and all covering but the top sheet and a 
light blanket removed. 

The under sheets in succession, including the rub- 
The under- ber, are then rolled as near as possible to the patient's 
ber sheet, back, while the clean under sheet which has been 

and draw- 7 

sheet tucked in firmly at top and bottom follows closely the 

soiled one. The rubber sheet is now unfolded and put 
back over the fresh under sheet, and the draw-sheet 
laid over it and tucked securely in at one end, the 
other folded portion being drawn closely to the 
patient. If this has been done carefully the roll of 
soiled and fresh sheets can be easily flattened, the 
patient gently rolled over it, and the other side of 
the bed made. 

To change the top sheet, first lay the fresh one over 
To change the soiled, and while the top one is being held by the 
sheet patient, if he is able, draw the other from under it so 
that there may be no exposure of the body. 



CHANGING THE NIGHT-DRESS 

The changing of a night-dress on a helpless patient 
To change, seems a very wonderful thing to those who for the 
gown is first time are watching it done by skilled hands, yet 

simple .. „ ' . ° i • , , . * 

it is a very simple matter, and requires only a little 
practice to accomplish without fatigue to the patient. 
The fresh night-dress, arranged to slip easily over the 
head, is first placed on the patient's chest. The soiled 
one is then gradually drawn up from under the back 
until it is well past the shoulders, when the sleeves 
can be easily slipped off, the head gently lifted, and 
the soiled night-dress exchanged for the fresh one. 
The nurse should slip her own hand through the fresh 



CARE OF BED PATIENTS 33 

sleeves at the wrist and, gently grasping the patient's 
arm, draw it through so that no effort on his part is 
necessary, and finally the rest of the night-dress must 
be pulled smoothly into place. The use of a short 
night-dress open in the back is sometimes of great Value of 
value with very ill patients, especially if frequent night- 
sponging is required, since it can so readily be slipped 
off. Any plain nightgown can be utilized for this 
purpose with very little trouble. 

In removing a nightgown or other garment from 
a person having a disabled arm, it is necessary to take 
off the sleeve from the well arm first, in order to give 
plenty of room for the other, and in putting on a gar- 
ment the process is reversed for the same reason. 

THE PREVENTION OF BED-SORES 

In cases of wasting disease or with aged or para- 
lyzed patients, there is a tendency to the formation of ^^event 
bed-sores, and unless one has had some experience bed - sores 
it is hard to realize in how short a time such a sore 
can make its appearance nor what extreme vigilance 
is necessary in order to prevent it. 

A bed-sore is really a part of the tissue of the 
body which is cut off through pressure from the circu- 
lation of the blood and which therefore becomes dead 
tissue. It is caused, as stated, by unrelieved pressure 
accompanied usually by heat and moisture, and those 
parts of the body where the bones are nearest the sur- 
face are naturally the places to be specially guarded. 
The hip-bones and base of the spine, the elbows, shoul- Where 
der-blades, heels, and even the tips of the ears should appear 
be closely watched for the slightest indication of red- 
ness or pricking sensation, which gives the first warn- 
ing of danger. If possible the position should be 



34 HOME NURSING 

changed from time to time, or if there is any reason 

why that can not be done some measures must be taken 

The Hng to relieve pressure. A rubber ring- is useful for the 

and horse- A ° 

shoe spine or hips if it is not blown up enough to make it 

hard. A very slight amount of air in the ring will be 




A Rubber Ring 



sufficient to lift the pressure and will prevent its being 
uncomfortable. The "horseshoe" air cushion, though 
more expensive than the ordinary round rubber ring, 
is very much more comfortable and more sanitary on 




Horseshoe Air-cushion 

account of its construction. Small soft rings made of 
cotton and wound with a bandage are very useful for 
lifting an elbow or heel, and can be renewed as they 
become soiled or out of shape. 

Besides the relief from pressure there must be an 
effort to increase the blood supply in the part in order 



CARE OF BED PATIENTS 35 

to build up new tissue. As in the case of the sick 
bodv as a whole we aim first at cleanliness, so here Alcohol 

1 1 1 • 1 1 c ana - ? entle 

we do the same and bathe with soap and water, follow- friction, 
ing this by the application of pure alcohol and gentle 
friction with the ball of the thumb, working always • 

toward the centre. The alcohol helps to harden the 
tender skin and the massage forces the blood through 
the surrounding tissue. Another measure for estab- 
lishing better circulation is the use of hot douching pouch- 
of the part, followed by cold. Care must be observed powder 
that the water is not hot enough to scald the tissues. 
This should be kept up for at least ten minutes night 
and morning. A little zinc oxide powder may be used 
to dust the surface and assist in absorbing moisture. 
Powders as a rule are better omitted, as they are apt 
to cake and form hard particles which do more harm 
than good to the tender flesh. 

It is necessary that the bed should be kept abso- 
lutely dry and smooth. Crumbs must be brushed out How the 
and the wrinkles smoothed frequently. It is some- of the 

bed helps 

times difficult to accomplish this, especially in the case 
of a paralytic or aged person when there is inconti- 
nence of urine to fight against. However, by the use 
of a sufficient number of thick pads about fifteen 
inches square, made of absorbent cotton covered with 
gauze or cheesecloth, it is possible to keep the bed 
dry, and the patient need never be left to lie on wet 
sheets. It is quite possible that the patient will object 
to such frequent disturbance as the changing of the 
pads requires, for at night also there will need to be 
several changes, but no objection on the part of the 
patient can outweigh the importance of this task, and 
a little tact and sweet temper, which we remember is 
always at the nurse's command, will usually pacify 
the unhappy one. 



36 HOME NURSING 

There should always be special bathing with warm 
Of need water after urination. This is essential not only in 
quent order that the patient may be kept quite clean and free 
from unpleasant odors, but because when a bed-pan 
• is being used the urine runs back between the but- 

tocks and is sufficiently irritating if left to dry to cause 
chafing and sometimes even a slight fissure. 

If once the skin becomes abrased the alcohol can 
£? sk?n of course be used only round the edges of the bed- 
abrasion SO re, which we must then regard as an open wound 
and treat accordingly. The advice of a doctor should 
be sought in such cases. It is always necessary to 
apply a dressing at once and small thin pads of ab- 
sorbent cotton covered with gauze or clean linen and 
fastened in place with strips of adhesive plaster will 
protect the sore from infection. 



LIFTING AND MOVING PATIENTS 

The expert lifting and moving of patients requires 
much practice, but a few hints may be useful in pre- 
venting the awkwardness one feels who has never 
taken care of sick people. 

In moving a patient from one side of the bed to 
Do not the other it is not necessary either to drag or pull him 
puii the over. One arm should be placed obliquely under the 
shoulders with the hand supporting the back, while 
the other is carried over and under the other shoulder. 
In this way half of the body can be lifted on to the 
fresh side. Then with one hand and arm under the 
lower part of the back and the other below the hips, 
the rest of the body can be drawn into place very 
gently. If the patient is able, he can assist by clasp- 
ing the hands around the nurse's neck. 

In raising a patient in order to readjust pillows, 



CARE OF BED PATIENTS 37 

support is given in the same way with the head resting in chang- 

110 J ^ mg pillows 

on the nurse's shoulder, while her free hand changes 
the pillows. 

To lift toward the head of the bed, the hand and 
arm are placed under the back as indicated above, and > v . hen two 

r join in 

the other hand under the hips, and the patient lifted lifting 
gently and steadily. If two people join in lifting, one 
on each side, in this way even a very heavy person can 
be easily moved. 

To change a mattress with the patient in bed 
assistance is necessary. One person draws the mat- Method 

.of chang- 

tress with the patient on it half way off the bed while ing the 

mattress 

the other mattress is slipped into place. The patient 
is drawn across by means of the sheet on to the fresh 
mattress, which can then be slipped the rest of the 
way on to the bed. 

If a patient is to be lifted on to a couch or easy- 
chair, it must be placed with the head toward the foot 
of the bed and near enough so that the persons lifting 
need take only a few steps. They should stand both 
on the same side of the bed and carrv hands and J.° change 

the patient 

arms well under the shoulders and buttocks of the* 0300 " 011 , 
patient, and then by simply wheeling about the couch 
can be reached. 

MECHANICAL APPLIANCES 

For a patient who is to sit up in bed the bed-rest 
is a very useful article, and the best kind is that hav- 
ing a simple wooden frame with canvas support. This Th e bed- 
can be put at various angles as desired, and with a 
hair pillow at the bottom to give firm support to the 
lower part of the back, and a small pillow for the head, 
the patient can be made comfo'rtable. It is best for 
him to have either a pillow under the knees or one to 
brace the feet against, so there need be no feeling 



38 



HOME NURSING 



of effort to keep from slipping toward the foot of the 
bed. 

The knee-pillow also gives great relief to a patient 

The knee- suffering from any abdominal pain, as it supports the 

legs in a flexed position and so relaxes the muscles of 




Canvas and Wood Bed-Rest 

the abdominal wall. The pillow should be a feather 
one, medium-sized, and not too thick, and it is best 
to have it covered with a rubber case under the linen 
one. A pillow tucked close to the back when the pa- 
tient is lying on one side or against the abdomen if 




A Cradle to Lift the Clothes 

there is pain there, when in the same position, relieves 
the strain somewhat and is found grateful to him. 
Small, soft pillows made of absorbent cotton, if noth- 
ing better is at hand, are much appreciated by patients, 
and can be tucked in various places to relieve pressure, 



CARE OF BED PATIENTS 89 

as between the knees when lying on the side or to lift 
an elbow or shoulder from the mattress. 

In arranging pillows to take the place of a bed- 
rest it is necessary to have four or five of good size, Substitute 

° - for the 

and they should be piled with each additional one bed rest 
placed behind the others in order to give the firmest 
support. A very useful though not elegant substitute 




The Iron Standard Bed Table 

for a bed-rest is a straight-backed chair inverted so 
that the back makes an inclined plane against which 
pillows can be laid. A bandage or other stout piece 
of cloth which is long enough if fastened securelv to An aid t0 

» t> 'a patient 

the foot of the bed serves as assistance to a patient 
not able to raise himself easily, alone. 

In some cases a frame known as a "cradle," 
which can lift the bedclothes from a sensitive bodv 



40 



HOME NURSING 



A cradle 
to lift the 
clothes 



or limb, is very much needed. These can be bought 
cheaply, but a very satisfactory one can be made in a 
short time by means of three or four split barrel- 
hoops wound tightly with bandage and fastened at the 
ends to two straight pieces of board about one and a 




% 




The Wooden Leaf Bed Table 



half feet long. This placed in the bed over the affected 
part affords relief and comfort. 

There are two kinds of bed-tables. One has an 

Bed tables iron standard which can be drawn close to the bed, 

and a wooden leaf reaching over it which can be 

fastened at any desirable height by means of a screw. 




Trabaud Back Protector on Douche Pan 

The other is a simple, light, and low table which can 
be placed on the bed with the legs resting on either 
side of the patient's body. A very good table can be 
fashioned with a cutting-board and a few books placed 
on either side of the patient to give it support. 



CARE OF BED PATIENTS 41 

A great need has been met in the appliance known 
as the "Trabaud Back Protector," which is a cushion Device to 

remove 

that can be attached to the douche or bed-pan, and pressure 

1 from the 

removes entirely the pressure upon the spine. It can s P ine 
also be used as a pillow after it has been detached from 
the pan if desired. 



Ill 



ENEMATA, SUPPOSITORIES, AND DOUCHES 

Administration— The Laxative Enema— The Purgative Enema— The Nutritive 
Enema— The Starch Enema— The Turpentine Enema— Rectal Irrigation- 
Suppositories— Douches— Gargles, Sprays, and Inhalations— Care of Utensils 



Defini- 
tion of 
enemata 



Laxative 
Nutritive 
Sedative 

Astringent 
Emollient 



Anti- 
spasmodic 



Anthel- 
mintic 



Antiseptic 



THE general term injection indicates the introduc- 
tion of fluids into the body. When they are 
carried into the intestines through the rectum we 
speak of giving enemata, though the general term 
injection is commonly made a specific one, and used 
instead of enema. 

There are many different kinds of enemata, as 
there are various purposes in their use. The classi- 
fication as given in Isabel Hampton's "Text-Book on 
Nursing" is as follows : 

Simple laxative and purgative enemata. 

Nutritive enemata for the introduction of nourish- 
ment. 

Sedative enemata for local or systematic effects. 

Astringent enemata, which check hemorrhages and 
diarrhoea, e. g., hot water or ice water, solution of 
alum or nitrate of silver. 

Emollient enemata for soothing irritated and pain- 
ful mucous membranes. Starch and certain drugs are 
used in solution for this purpose. 

Antispasmodic enemata, to relieve flatulence, in 
which, for example, turpentine is used in solution. 

Anthelmintic enemata for destroying worms: salt, 
turpentine, and quassia are used in solution in this way. 

Antiseptic or germicidal enemata, used in the vari- 
ous forms of dysentery. 
(42) 



ENEMATA 45 

THE LAXATIVE ENEMA 

The laxative enema may be better if the bowels are 
particularly sluggish, and the use of olive or cotton- The meth- 
seed oil or a little glycerine will usually be sufficient oil enema 
to correct the difficulty. Six ounces of oil should be 
warmed to blood heat by placing it in a vessel of hot 
water and then very slowly injected by means of a 
hard rubber syringe with a soft rubber tube attached 
to the nozzle. It is important that the oil be given 
with great deliberation, in order that it should be re- 
tained easily. The warming of the oil is necessary for 
the same reason, because oil injected cold will cause 
pain and there will be an intense desire to reject it 
at once. The use of the hard rubber syringe is better, 




□ 



Hard Rubber Syringe 

because oil is injurious to the soft rubber and a bag 
once used for oil enemata is soon destroyed. 

The oil enema is best given at night and followed 
by a soap-suds enema in the morning, though if for 
any reason it seems more convenient, the oil may be 
given in the morning and retained for an hour or two 
previous to the soapy enema. 

One should be somewhat cautious in the use of 
glycerine, since its effect is to increase the peristaltic Care in 
action of the bowels, and in some cases its irritating fnem" ne 
properties are so great as to cause an inflammation of 
the mucous membrane lining the intestines, producing 
pain and diarrhcea. In such a case much relief can 
be afforded by an irrigation of the bowel with normal 



46 HOME NURSING 

salt solution, the use of which will be spoken of 
later. 

The glycerine enema is usually given in amounts 
varying from half a teaspoon to half an ounce and 
diluted with an equal quantity of warm water. It is 
seldom necessary to follow a glycerine enema with a 
soap-suds one, as with the use of oil. 

THE PURGATIVE ENEMA 
A purgative . enema is made with drugs,, such as 
turpentine, castor oil, or Rochelle salts. In obstinate 
cases of constipation, the enema may be given high up 
in the bowel by the use of a soft rubber catheter or 
• rectal tube attached to the end of the syringe and in- 
serted six or eight inches. 

The bowels should not be allowed to become ac- 

Caution customed to the habitual use of the enema, as by so 

tifeTnema doing the natural action is weakened. Various means 

of overcoming the tendency to constipation will be 

cited in a later chapter. 

THE NUTRITIVE ENEMA 
The nutritive enemata are resorted to when feeding 
by the stomach needs to be suspended or supplement- 
ed by additional nourishment to be administered per 
rectum. Concentrated foods are employed and the 
Concen- physician in charge of the case will usually wish to 
suggest the formula for use. Two simple formulae are 
as follows : 

i. One whole egg, 
Pinch of table salt, 
Three ounces of peptonized milk, 
Half an ounce of brandy. 
Or, 2. The whites of two eggs, 

Two ounces of peptonized milk. 



ENEMATA 47 

Each one of these makes about four ounces, the 
amount that should be given at one time. It should 
not be given oftener than once in four hours or six 
times in the twenty-four hours. The frequency, how- 
ever, will be regulated by the physician, according to 
the special requirements of the patient. 

The absorptive power of the rectum is less than 
that of anv other part of the intestines. This kind of Nutritive 

J r enema 

enema therefore should be given as high as possible, g^en^as 
using the rectal tube or soft rubber catheter for the possible 
purpose. 

A simple enema should precede the first nutritive 
one, in order to clear out the bowel, so that ready ab- 
sorption of the nutritive substance can take place. If 
there is a continued use of the nutritive enema, we 
shall find that some part remains unabsorbed in the 
bowel, causing irritation of the mucous membrane as 
it decomposes. It is therefore necessary that the in- 
testines should be flushed with warm water as often After care 
as once in twelve hours in order to free the bowels of 
the unabsorbed material. 

Medication may be given rectally when it is likely 
not to be retained if given by mouth. It should always 
be given with the tube inserted at least six inches. 
In case of hemorrhage from the bowels, hot water or 
ice water injections may be ordered and should be 
given with a fountain syringe hung rather low so 
that the force of the stream of water will not be too 
great. 

THE STARCH ENEMA 

In cases of dysentery or diarrhoea, a starch or gruel 
enema is frequently useful. The starch should be How made 
cooked as for laundry use and thinned till it can pass 
easily through the syringe. It should be given slowly 
and gently through a rectal tube. 



48 



HOME NURSING 



Guard 

against 

burning 



THE TURPENTINE ENEMA 

The turpentine enema may be given in cases of 
distressing flatulence and frequently affords great re- 
lief. Ten drops to a pint of water is the amount gen- 
erally used, and it should be very thoroughly mixed 
with the water, in order to guard against the possibil- 
ity of burning. 

RECTAL IRRIGATION 

Rectal irrigation differs only from enemata in that 
the water is not meant to be retained in the bowel, the 
object being merely to wash out the irritating sub- 
stances there which may be the occasion of a diar- 
rhoea. The water is allowed to run slowly into the 




Rectal Tube with Return Flow 



The tube 
for rectal 
irrigation 



bowel and may be expelled at once. It should be con- 
tinued until the flow of water is clear, showing that 
the bowels are freed from irritating matter. 

A rectal tube with return flow is convenient for 
giving an irrigation, since it obviates the necessity of 
inserting the tube several times, though if done care- 
fully this need cause little irritation. 

A salt solution (one teaspoon of common salt to a 



SUPPOSITORIES 49 

pint of warm water) is generally used for irrigation, 

as it is at the same time somewhat stimulating. In The salt 

r 1 i n -i 1 solution 

cases of shock or collapse or with very weak patients, enema 
the saline or salt solution enema is often ordered. In- 
troduced in this way it is taken up quickly by the tis- 
sues and increases the volume of the blood supply, 
which has become depleted and thus renders the heart's 
action more normal. 

For the green stools so common in the case of 
babies, rectal irrigation twice a day at first, and as the 
stools improve once a day, together with careful feed- 
ing, is often a means of entirely correcting the trouble. 

SUPPOSITORIES 

Suppositories are small solid cones of various sizes, 
usually made of cacao butter and medicated. These are 
largely used for introducing into the rectum to take the 
place in a measure of enemata, and, though retaining 
their shape under ordinary conditions, melt readily at 
the heat of the body. 

The suppository should be oiled with vaseline and 

carried with the index ringer gently into the rectum, introduc- 

The finger should be inserted its entire length, and if the sup- 
• , -1 1 . r - p° sit » r y 

the patient at the same time bears down as if to expel 

it, a certain amount of suction is produced which car- 
ries it further up into the bowel. By holding the finger, 
after it has been removed, a moment over the opening 
to the rectum till the bowel has become accustomed 
to the foreign body, there will be less likelihood of its 
being expelled. A suppository should act in fifteen 
or twenty minutes, and meantime the patient should 
remain quiet in the recumbent position. 



Vol. 3 



50 HOME NURSING 



DOUCHES 



By the term douche is meant "a jet of fluid direct- 
of e douches e< ^ with a certain amount of force upon a limited sur- 
face external or internal." Those given internally are 
the nasal, aural, and vaginal douches. 

Douches may be either of plain water or medicated, 
and are given for cleanliness, to reduce inflammation 
and for the purpose of stimulation. 

The vaginal douche of plain water given for clean- 
doSe 1 Hness should be tepid, and a quart or a quart and a half 
is a sufficient quantity. The hot douche, ordered to 
check hemorrhage or to allay inflammation of the pel- 
vic organs, is given in larger quantity — from two to 
four quarts being the amount usually used — and at a 




Douche Pan 

temperature ranging from 112 F. to n8° F., according 
as the patient can bear the heat. The prolonged appli- 
cation of the hot water causes after the first expan- 
sion of the blood-vessels a contraction which is more 
or less lasting and by that means hemorrhage is 
checked. 

Any medication which is to be given in the douche 
Position should be included in the last quart. It is necessary 
patient that the patient should be in a recumbent position as a 
douche is of very little effect if taken sitting. Further- 
more it is always advisable that she remain lying down 
for a half-hour after the douche, as it has a somewhat 
weakening effect upon the tissues. 



DOUCHES 51 

Douche pans may be bought at little cost, or in case 
of emergency a new tin pan large enough for the pa- 
tient's buttocks to rest in can be utilized successfully. 
The fountain syringe is generally preferred for giving 
douches, as the flow of water is steady and under low 
pressure. If used after operative cases, it is wiser to 
hang the bag rather low so that the force of the stream 
may not be too strong upon the bruised tissues. 

The best nozzle is the glass one, which can be kept 
absolutely clean bv boiling for twenty minutes. Care The glass 

" . ° , , , , nozzle best 

must be taken in the use of glass or metal nozzles, that 
they are not inserted too hot, as they retain the heat, 
and there is danger of burning the delicate membrane 
lining the vagina. 

The water 'must be allowed to pass through the 
tube before the nozzle is inserted, to expel the air and 



Glass Nozzle 

cold water as in the case of any injection. The per- 
forations of the nozzle should always be at the side, Use ex- 
never in the end as in that used rectally, since in that 
case there would be danger of injecting the fluid into 
the uterus and thus causing serious trouble, particular- 
ly in confinement cases, where the mouth of the uterus 
remains partly open. 

For douching the ear, a medicine dropper makes a 
very good nozzle. It can be attached to the tube of a in douch- 

£ . . ri in & the eal * 

fountain syringe and the flow can be governed by 
pressure of the fingers. It is important here, as in 
vaginal douching, that the force of the stream of water 
is not too great. By drawing up the tip of the ear 
very gently, the auditory canal is straightened, giving 



52 HOME NURSING 

more ready access to the inflamed area. Cold water 

should never be injected into the ear. 

The same precaution against the use of too great 
Nasal force in douching is applicable to the nasal douche, as 
and neces- there is danger of perforation of the extremely delicate 

sary care or j 

tissues, if care is not exerted in its use. The use of the 
nasal douche should never be made habitual. Physi- 
cians who make a specialty of ear diseases object par- 
ticularly to this method of treatment, since it often 
sets up an inflammation of the ear. If an attempt is 
made to blow the water forcibly out of the nose, one 
can feel it distinctly in the passage leading to the ear. 
It is in this way that the harm arises, consequently if 
the nasal douche is used the head should be held down 
and the water allowed to drain out of the nose before 
the handkerchief is used at all. 



GARGLES, SPRAYS, AND INHALATIONS 

Gargles are employed for cleansing and medication 
Orgies °^ ^ e throat and tonsils. A generous swallow should 
be taken and used vigorously for four or five succes- 
sive times, and as frequently during the day as di- 
rected or as indicated by conditions. 

A severely inflamed throat in which the mucus col- 
lects rapidly should be gargled as often as once an 
hour. In mild conditions three times a day may be 
frequent enough. After the use of an acid gargle the 
mouth should be thoroughly rinsed with a solution 
of some alkaline substance, such as bicarbonate of 
soda, to counteract the effect upon the teeth of the 
strong acid. 

For simple sore throat a glass of water with a 

throat 6 teaspoon of salt or alcohol diluted two-thirds with 

water, makes a good gargle. For tonsilitis, peroxide 



DOUCHES 53 

of hydrogen one part in five of water is very cleansing 
and gives great relief. 

Insufflation, or the blowing of a powder into a 
cavity, may be accomplished by means of a glass insiif- 
tube or a hollow roll of stiff paper containing the 
prescribed powder. This must be placed far back in 
the throat and can usually be forcibly inspired by the 
patient, though if necessary the nurse can blow the 
contents through the tube. The atomizer is in general 
use now for spraving the nose or throat, and its use A sim- 

. ° . pie ato- 

needs no explanation. Inhalation of steam can be mizer for 

r > > bronchial 

given by means of a pitcher of boiling water, having colds 
closely fitted over it a thick paper cone with a hole 
large enough for the patient to breathe through. In 
this way none of the vapor is lost, and the patient 
receives it by the mouth and exhales through the nose. 
This treatment often affords great relief in cases of 
severe bronchial cold when there is considerable diffi- 
culty of breathing. 

CARE OF UTENSILS 

After a syringe has been used it must be washed 
in soap-suds, rinsed in hot water, and hung up to dry. Care of 
It should never be put away in the box wet. Hard 
rubber syringes, if not frequently used, are apt to leak. 
The leakage can usually be avoided by soaking before 
use in hot water, which swells the washers sufficiently 
to make them tight. 

The nozzle, after being washed, should be left 
standing in a solution of carbolic acid. The long- rub- Care , of . 

° nozzle and 

ber rectal tube or soft catheter, after being thoroughly rectal tube 
washed, can be boiled two or three moments before 
it is put away. This softens the rubber somewhat, and 
eventually spoils the tube, so that if left standing for 



54 HOME NURSING 

some hours in a strong solution of carbolic acid the 
same end is attained. 

A bed-pan should be warmed by allowing the hot 
Getting water to run over it before giving it to a patient. If 

the bed- . ,..,.„, . . 

pan ready the patient is very stout and it is difficult to get it into 
place, the edges may be oiled a little. Sometimes, with 
very thin or emaciated patients, it is necessary to pad 
the edges of the bed-pan, as a bed-sore may be started 
from frequent or careless placing of the pan. 



IV 



OBSERVATION OF SYMPTOMS 

Circulation— How to take Pulse— Temperature— Use of Clinical Thermometer 
—Respiration— Observation of Symptoms 

ANY ONE who has the care of the sick should 
know how to observe accurately the changes What use 
J ° tempera- 

in temperature, pulse, and respiration, since these, ture, pulse, 
are essential guides to knowledge of the progress ration 
of disease. 

CIRCULATION 

Some idea of the structure of the organs of circu- 
lation and the office of the blood may possibly be 
helpful to an understanding of normal and diseased 
conditions. 

The blood is the most important fluid of the body, 

and its office is to convey nutritive material to all parts Offices of 

, • ttVi the blood 

of the system and to bring away waste matter. When 

examined under the microscope the blood is seen to 
consist of a thin, colorless fluid in which float millions 
of small solid bodies known as corpuscles. The liquid 
is called plasma and the corpuscles are of two kinds, 
the work of each differing somewhat. The red cor- 
puscles are known as the oxygen carriers, while the 
white ones, on account of the work they do, have 
sometimes been spoken of as the "scavengers" of the 
body. The blood when removed from the body and 
exposed to the atmosphere has a tendency to clot, and 
it is this property which prevents severe hemorrhage 
following even slight wounds. 

(55) 



56 HOME NURSING 

The organs of circulation are the heart and blood- 
The great vessels. We can form some idea of what the strength 
circulation of an organ must be which can pump out huge streams 
of blood night and day without cessation throughout 
a lifetime. And so it is that the heart is fashioned 
of strong, thick walls of muscular tissue, the contrac- 
tions of which force its contents through the tubes 
which are meant to convey the blood to all the tissues 
of the body. It is enveloped in a membrane which 
secretes a lubricating fluid that prevents its move- 
ments from meeting with any friction. It also has a 
very delicate lining and the congestion of either of 
these membranes gives rise to disease. 

The heart is partitioned into four cavities with a 
Details complicated and very beautiful arrangement of valves, 
work The blood brought to it by one set of blood-vessels, 

known as arteries, is carried away by others called 
the veins. The larger arteries, which receive and pass 
along the blood that the heart contains, are necessarily 
of firmer tissue and more elastic than are the veins 
which merely convey the stream of blood back to the 
heart again. These blood-vessels are constantly 
branching and diminishing in size as they divide. 
Their walls also become much thinner as they ap- 
proach the capillaries or network of extremely delicate 
blood-vessels which unite them and in which the ex- 
change of waste and nutritive material takes place. 
This pumping of the heart can be felt over its apex, 
its pump- which lies a little to the left of the centre of the chest, 
ou g r pSise- and also along the course of the large arteries as they 
approach the surface of the body. Pulse is the peri- 
odic distention of the blood-vessels due to this con- 
traction of the heart. The blood is forced from the 
heart into the arteries, and because of the elastic char- 
acter of the arterial walls is carried on throughout the 



beat 



OBSERVATION OF SYMPTOMS 57 

entire arterial system. The condition of the heart 
is indicated by the character of the pulse-beat, which 
may be felt whenever a large artery comes near the 
surface of the body. The usual place for counting 
the pulse, because it is most convenient, is at the wrist, 
though it may be felt also at the temporal artery and 
at the neck and ankle. 

HOW TO TAKE PULSE 

It is sometimes difficult for one not accustomed to 
taking the pulse to do so readily, but if counted at the To find 
wrist the artery is easily found by carrying the first 
two or three fingers lightly down the outer edge of 
the thumb until they rest on the artery just at its base, 
where, with very slight pressure, the pulsation may 
be felt and the rate counted for a half-minute. The 
fingers should be used instead of the thumb in feeling 
the pulse, because of a pulsation in the thumb itself, 
which interferes with the correct count. 

The normal pulse-beat for an adult varies between 
sixty and seventy in a man and sixty-five to eighty in The nor- 

a 1 m i> 1 1 • i ma l pulse- 

a woman. A child s pulse varies between ninety and beat 
one hundred. The pulse-beat even in health changes 
somewhat with age, sex, climate, position, exercise, 
and other conditions. It is apt to be more rapid in 
women than in men, slower in sleep than when awake, 
quicker just after taking food and more rapid stand- 
ing than sitting or lying down. There may be con- 
siderable variation within the limits of health." 

The character as well as the rate of the pulse 
change under abnormal conditions. It may be full or Character 

., . of the 

small according to the volume of blood coursing P ulse 
through the vessel. When it can be stopped easily on 
pressure it is said to be compressible. It may be 



58 HOME NURSING 

irregular if the length or force of the beats differ 
from one another, or intermittent if a beat is omitted 
from time to time. An intermittent pulse may exist 
even in health, but an irregular pulse is usually re- 
garded as more serious. When the perfect action of 
the valves of the heart is interfered with, the pulse 
at once shows irregularity. 

In sickness the pulse indicates how the system is 

in sickness enduring the attack of disease. In most cases the 
pulse is quickened by disease and the more frequent 
the number of beats the weaker generally is the con- 
dition of the heart. 

The effect upon the pulse of any medication should 

Effect of be carefully watched. Stimulants of course increase 

medication ■ 

the strength and frequency of the hearts action, 
while drugs which are given to reduce fever have a 
depressing effect upon the contractions of the heart, 
and render the pulse slower and weaker. 

We should not, however, consider the pulse by 
itself in disease. 

TEMPERATURE 

The regulation of the body's heat is interfered 
Normal with in disease, and the ratio maintained between 
th e at bod y pulse, temperature, and respiration is always signifi- 
cant. The evenly balanced production and escape of 
the heat of the body keeps its temperature normally 
at about 98.4 F., in spite of variations in the ex- 
ternal conditions of heat and cold. The normal 
standard we may say lies between 97^4° and 99^°, 
according to the time of day when the temperature 
is taken, and the variation of even a degree from this 
should be regarded as abnormal. The temperature 
of an adult is said to reach its highest point between 
5 and 8 p. m v and is lowest from 2 to 6 a. m. The 



OBSERVATION OF SYMPTOMS 59 

range of temperature within which life can be sus- Range of 

. , . , , , the tem- 

tained is about twenty degrees — we may say between perature 
95° and io8° F. The danger of either a very high or 
very low temperature is chiefly in the length of time 
the condition lasts. Very high temperature is some- 
times found in cases of hysteria without danger to 
life, but that is because the temperature soon drops 
to normal. 

Most disorders are accompanied with rise of tem- 
perature, though this is by no means essential to a 
condition of disease. 



THE USE OF THE CLINICAL THERMOMETER 

Every household should possess a clinical ther- 
mometer. This is a frail little instrument, the glass 

A Clinical Thermometer 

of which usually magnifies so that the rise of the 
mercury can be easily traced. The mercury should 
be shaken down below QS° before it is used. The Use of 

- , . . , the clin- 

time required for it to register will usually be indi- ical ther- 
cated on the thermometer or explained where it is 
bought. These instruments are self-registering, i.e., 
the mercury remains stationary after the thermome- 
ter is withdrawn until it is forcibly shaken down. 

The temperature can be taken either in the mouth, 
axilla, rectum, or groin. If taken by mouth the Ways of 
thermometer should be placed under the patient's the body's 

. , tempera- 

tongue, being careful that the teeth do not close sud- tu re 

denly upon it and that the lips are kept firmly held 

together. When the temperature is taken by axilla 

the armpit should first be wiped dry, the therome- 



60 HOME NURSING 

ter laid in place, and the arm held closely to the side, 
with the elbow flexed. It is better that the attendant 
should hold the arm in place if the patient is weak, 
so that there need be no effort on his part. The 
thermometer should be left in place eight or ten 
minutes. 

The rectal temperature is the most accurate, and 
The most should invariably be taken in the case of children and 

3.CCtir3.t6 

tempera- in serious illness where great exactness is demanded 

ture - fe 

or if for any reason the temperature by mouth is 
questioned. A little vaseline on the bulb of the 
thermometer makes it easy to insert, and it should 
be carried in an inch and a half. Often the patient 
is able to do this for himself. Rectal temperature is 
always a half-degree higher than that taken by 
mouth or axilla. 

The temperature of a delirious person should 
When the never be taken by mouth, for fear of accident, and 
delirious care should be observed in any case not to give a 
hot or cold drink just previous to taking the tempera- 
ture. 

Upon the first sign of illness the temperature 
should always be taken. It may be found only slight- 
ly elevated, but if each day shows an increase of 
temperature, how*ever slight, a physician should be 
consulted. A rise of temperature beginning each day 
a little earlier is not a good indication. 

The temperature of a sick person should be taken 
How often at least twice a day, and in some cases it is necessary 

the tem- J 

peratm-e to take it every hour or two. A morning temperature 
taken ' ma y be normal when the evening temperature will 
show a considerable elevation. 

The thermometer, after it has been used, should 
be washed off with soap and water and carefully 
dried. It must not, however, be held under the hot- 



OBSERVATION OF SYMPTOMS 61 

water faucet, as is sometimes done by careless hands. 

If the thermometer has not been thoroughly dried Care of 

° J the chn- 

before being put back into the case, the latter grows icai ther- 
musty, so that the thermometer when taken out has 
an unpleasant odor, which is detected at once if a 
mouth temperature is taken. It is always well to 
wipe the thermometer with a damp cloth before giving 
it to a patient. If it is in constant use it may be kept 
in a glass of some antiseptic solution. A bit of cot- 
ton may be placed in the bottom of the glass for the 
bulb to rest upon. 

RESPIRATION 

The processes of circulation and of respiration 
are closely allied and what affects the pulse is apt 
also to influence the breathing. The blood which is 
collected from all parts of the body and sent to the 
lungs is then purified by being brought in contact 
with the air. The lungs are sponge-like bodies com- The lungs 

i r ■ ■ 11 i • 11- and their 

posed ot minute sacs or air-cells having very delicate action 
walls surrounded by a network of capillaries. The 
capillary membrane is extremely thin and of a re- 
markable structure which permits the passage of 
gases, and of nutrient material held in solution, 
through it to the tissues. Hence the interchange of 
gases that is possible in the lungs. The oxygen 
which has been drawn into the lungs is taken up by 
the red corpuscles, which have a great affinity for it, 
and the carbonic acid and water in the blood, having 
an equal affinity for the air, pass into it. 

The rate of respiration varies as does the pulse, . 
and is also influenced by position, emotion, exertion, Rate . s of 

• . J l respiration 

and other conditions. The respirations can be 
counted either by watching the rise and fall of the 
chest or by placing the hand upon it. They are best 



62 HOME NURSING 

counted when the patient is asleep or unaware of 
being observed, as otherwise there is likely to be an 
unconscious control. If the hand is left a moment 
on the wrist as if still taking the pulse the respiration 
can easily be counted. 

The average number of respirations for a healthy 
Average of adult is eighteen to the minute, and in a child from 

respiration " . 

twenty to twenty-four. The ear should be trained 
to detect readily a change of breathing if it should 
take place, as is frequently the case in the night. 



OBSERVATION OF SYMPTOMS 

One who is constantly with a sick person has an 

How the excellent opportunity of noting his true condition, and 

hei rse th nay can ^ e °f ver y rea l assistance to the doctor if she has 

physician the keenness to observe closely and can report in a 

simple and direct way all the changes that may have 

taken place between his visits. 

Some patients are inclined to exaggerate their ills, 
while others make light of them, and it may some- 
times be difficult to distinguish between real and im- 
aginary disturbances. The attitude a patient takes 
The atti- or his expression often suggests the nature of his 

the patient trouble. For instance, a person with pain, tender- 
suggestive 

ness, and distention of the abdomen lies on the back 

with the knees flexed in order to reduce the tension 
of the abdominal muscles, while in the case of colic 
a person frequently prefers to lie flat on the abdomen, 
as the pressure upon it seems to give some relief. 
When one lung is congested the patient turns natu- 
rally toward the affected side in order to give the 
well lung freedom of motion. When there is great 
difficulty in breathing, as in asthma or in heart dis- 
ease, the patient can not lie down, but must be 



OBSERVATION OF SYMPTOMS 63 

bolstered up in bed day and night. As relief is 
gained the recumbent position is resumed. Patients 
who are extremely weak often slip toward the foot 
of the bed. This is considered a sign of failing 
strength. 

Great restlessness is also often an unfavorable 
svmptom. Sometimes in the course of disease the other 

1 symptoms 

arm or hand is kept constantly in one position. This 

is significant of some brain affection, as is also 

grinding of the teeth or rolling the head from side to 

side. Any swelling of the face or other parts of the 

body should be reported at once, whether or not it is 

attended by pain. Any unusual facial expression 

should be regarded as noteworthy. If breathing is 

difficult the distended nostrils may be the first sign 

of it. Any contortion of the muscles, however slight, 

should be regarded as significant. 

A chill is always considered a serious symptom, 

whether in the course of disease or otherwise. If Serious- 
i • iiii- i ness °f a 

the person is apparently well this may mean the onset chin 

of some acute trouble. The patient should be given 
a hot drink, abundant covering, and hot-water bags. 
The temperature must be taken and the doctor noti- 
fied. High fever is sure to follow a genuine chill. If 
a chill occurs in the course of an inflammatory con- 
dition, it is probably due to the formation of pus, 
which must be given an outlet. In malaria the chills 
are prolonged and often severe, but are seldom re- 
garded as alarming. 

One should be able to describe the character of 
a cough, whether it is dry, i. c, without expectora- Charac- 
tion, or loose ; whether short, frequent, choking, in- cou s h and 
cessant, or if it is more troublesome at night or after 
eating. The sputum or expectorated matter should 
be examined and often must be saved for the doc- 



64 HOME NURSING 

tor's inspection, as it has a characteristic appearance 
in various diseases. 

If there is perspiration the amount and character 
Perspira- of the moisture should be noted when it first appears, 

tion 1 , 1 • • ,1 

and whether it is warm or cold. 

When there is persistent vomiting the vomited 
matter must also be carefully described or saved in 
a covered vessel for the doctor to see. It should be 
observed also whether vomiting follows immediately 
the taking of nourishment or seems to have no con- 
nection with it. The same care is necessary regard- 
Abnormaii- ing the observation of stools and the necessity of 

ties in ° J 

aSd^tolis sav ^ n §" anything which appears abnormal. Curds may 
be seen and are easily recognized if milk is not being 
digested. Some drugs affect the color of the stools 
so that they might appear alarming if one were 
ignorant of this. Iron and bismuth blacken the stools. 
The presence of blood gives them a dark color and 
tarry consistency. In cases where the function of 
the gall-bladder is interfered with the stools are clay- 
colored. 

The condition of the tongue and mouth is signifi- 

The sig- cant. Note the color of the tongue and if it is coated, 

nificant ■ ° , 

tongue and dry, swollen, or bitten. In fever cases it is almost 

mouth •" ' ■ 

always furred, though this condition is. not absolutely 
a sign of ill-health. When the tongue begins to clear 
from the edges it is a sign that the intestinal tract is 
resuming its normal condition and improvement may 
be looked for daily. The odor of the breath and the 
condition of the gums and throat also indicate the 
state of the stomach. 

The color and texture of the skin is another thing 
what that is significant in disease. The skin may be yellow, 

stones ^ « 

Sa s te8 as * n J auncn ce, showing that the liver is disordered; 
waxy, as in Bright's disease of the kidneys; anaemic 



OBSERVATION OF SYMPTOMS 65 

or pallid, showing a lack of red corpuscles in the 
blood; or mottled, or covered with an eruption. Any 
eruption in the course of disease or any unusual rash 
appearing in apparent health should be reported to 
the physician. The place of its first appearance should 
be noted, as also the character of the eruption and 
the patient's general condition. A rash may be due 
to the development of some contagious or infectious 
disease, to the effect of some poison in the system, 
or may result simply from a disordered state of the 
digestion, but the doctor should always be the one to 
decide upon the matter. 

The condition of the kidneys is detected by the 
examination of the urine, which in health will appear Considera- 

. . tion as to 

of a pale amber color, with characteristic odor, the urine 
and should be voided to the amount of about 
fifty or sixty ounces in the twenty-four hours. 
Some variation is expected in health, due to 
the season and the amount of liquids taken 
into the system. In winter the urine shows a larger 
amount and is paler than in summer, when there is 
more loss of water through perspiration, and there- 
fore a more concentrated and highly colored fluid. 
Under diseased conditions the urine should be care- 
fully measured each time it is voided, in a measuring 
glass kept for the purpose and used for nothing else. 
Any sediment, opacity, unnatural color, or odor 
should be noted. The doctor may wish at any time 
a specimen of the urine for examination, and unless when the 
otherwise stated the first urine voided in the morning wishes a 
should be saved in a perfectly clean and dry bottle. 
Under some nervous conditions, as when one has a 
severe headache, the urine is voided very frequently 
and is paler than normal urine. The increased amount 
is also a characteristic of hvsteria. Retention of 



66 HOME NURSING 

urine means the complete inability to void it, and we 
have already spoken of that as a condition which 
must receive attention from the doctor or skilled 
nurse. 

The suppression of urine, however, is a much more 
Suppres- serious complication, and implies, not as in retention, 

sion of r 

urine that the muscles around the neck of the bladder re- 
fuse to act, but the inability of the kidneys themselves 
to perform their function, the bladder being found 
empty upon catheterization. Unless these organs can 
be forced to act, and will respond to treatment, the 
issue must be fatal, as the system soon becomes thor- 
oughly poisoned through absorption of the waste 
matter which should be thrown off by means of the 
kidneys. 

Incontinence of urine or lack of power in the blad- 
inconti- der to retain its contents is common as old age advances 
urine and the muscles are inclined to relax. The same con- 
dition exists sometimes in disease and implies extreme 
weakness. Incontinence may sometimes accompany 
retention of urine, the bladder being so full that some 
of the contents dribble away. None of these conditions 
should be kept from the knowledge of the physician. 
Painful and frequent urination may indicate an irri- 
tated and inflamed state of the bladder, and treatment 
is always necessary in order to hasten relief. 

The eye is sometimes the first thing to indicate a 
indka- general disorder of the system. It may be unduly 
the eye prominent, as in a disease of the thyroid gland known 
as goitre, or the pupils may be abnormally or unevenly 
contracted or dilated. Sometimes the eyelids droop, 
as in certain nervous disorders, or there may be squint- 
ing, which accompanies brain trouble. Pufrmess about 
the eyes and face suggest heart or kidney difficulty. 
The color of the eyeball may be abnormal or the eye 



OBSERVATION OF SYMPTOMS 67 

take on an unnatural brightness or peculiar lack of ex- 
pression, all of which is significant in disease. 

Hearing, too, is sometimes temporarily impaired by 
disease, as in the deafness accompanying typhoid fever, state of 
but often this sense becomes more acute than in health. 
An increased keenness of hearing may precede deli- 
rium. Any discharge from the ear should always be 
noted as to its character and amount. 

The mental state is subject to frequent changes in 
disease. If there is delirium, notice its character, The ner - 

' vous men- 

whether it be. mild, muttering, or inclined to be violent. tal state 
A delirious patient should never be left alone for an 
instant, no matter how mild the nature of the delirium, 
for at any moment an idea may seize his brain and be 
instantly acted upon, which might bring fatal con- 
sequences. Many such accidents have resulted from 
a delirium thought to be mild and therefore not need- 
ing special watchfulness. Any manifestation of a ner- 
vous character, such as incoherency of speech, dulness 
of intellect, difficulty of swallowing, involuntary twitch- 
ing or actual convulsions, are grave symptoms. Ob- 
serve the mental state before, during, and after a con- ^ t l° r T l and 
vulsion, whether the attack is sudden, how long it lasts, convulsion 
and whether the spasms are general or confined to one 
part of the body. 

Sleeplessness may be regarded as a serious condi- 
tion, according to the length of time it lasts. Watch- sieepiess- 
fulness is necessary in order to make an accurate re- 
port as to the amount of sleep a patient actually ob- 
tains in the twenty-four hours, since it is never safe 
to trust to a sick person's account of himself and the 
short naps which he has been able to get if summed 
up may amount to several hours of sleep. It is never 
wise to oppose any statement in regard to the lack of 
sleep, as it can do no good and only irritates a nervous 



68 HOME NURSING 

person. He may be soothed and his mind diverted from 
the troublesome subject in the various ways that sug- 
gest themselves to a thoughtful person. 

The careful observation of symptoms added to 

ftlfobser" g"°°d reasoning as to their meaning will often throw 

Symptoms muc h % nt on the disease in question and make the 

nursing of a case more than mere drudgery if one has 

any taste along scientific lines. 

A little judicious questioning of the doctor, if he 
is inclined to give explanation, will interest him and 
add much to the intelligent understanding of the work 
to be done. Close observation of symptoms, however, 
is of small account if there is no attempt to report con- 
ditions to the doctor in an accurate and orderly fashion. 
The memory ought never to be relied upon, but 
The value notes of some kind should be kept in the sick-room and 
written important points recorded from time to time. A neatly 

statement \ r J 

written statement simplifies the account for the doc- 
tor and will be much appreciated by him, whether he 
takes the trouble to show it or not. A sheet of ruled 
paper with columns marked off in which to tabulate 
the time, pulse, temperature, respiration, nourishment, 
sleep, urine, and stools, with a margin where remarks 
can be added, will be found a convenient form of keep- 
ing the record. A small blank book in which the doc- 
tor's orders can be written is also a valuable acquisition. 



INFLAMMATION, EXTERNAL APPLICATION, 
MEDICINES 



Inflammation— Treatment— Dry Heat— Hot- Water Bags— Moist Heat— How 
to Make a Poultice— Fomentations— Cold Applications— Ice Coils— Counter- 
irritants— Massage— The Giving of Medicine— Hypodermic Injections- 
Care of Medicines 



A 



INFLAMMATION 

LARGE number of diseases, both medical and sur- 
gical, are of an inflammatory nature at some time 



during their course ; all diseases the names of which 
terminate in "itis" are understood to be inflammatory. 
Inflammation implies changes in the tissues, which are 
brought about by certain irritants. These irritants, How con- 
whatever they may be, cause a larger amount of caused " 
blood than is usual to be sent to some part of the 
body. This condition is known as congestion. It 
means that the tissues can not take up the excess of 
nutritive material fast enough, that the capillaries be- 
come clogged, and that there is an oozing of some of the 
constituents of the blood into the surrounding tissues. 
The congestion may slowlv disappear in a few days, The resuit- 

i • r i- 1 • r. • i- 11 in S inflam- 

but if not soon relieved, inflammation must follow, mation 
This state is characterized by pain, swelling, tenderness, 
heat and redness. It may subside by gradual return to 
a healthy condition, or it may go on to suppuration, 
which is the formation of pus or matter. 

If for any reason inflammation takes place, the 
white corpuscles of the blood, which we have called the 
scavengers, hasten to the spot, make their way through 

(69) 



70 HOME NURSING 

the walls of the blood-vessels and begin their work of 
absorbing the irritant. If they are successful, we say- 
that resolution has taken place and the inflammatory 
condition disappears ; but if not, the symptoms of red- 
ness, swelling, pain, etc., increase in severity and pus 
is formed. If the inflammation attacks mucous sur- 
yvhen pus faces, there will be a natural outlet for the pus, as these 

is iormed L 

surSces US a ^ wa y s * ea d to tne external membrane of which they 
are merely a turning in, and with drainage thus estab- 
lished the inflammation will probably subside. If, 

Uvous however, a serous membrane, as those are called 

membrane w hich line the cavities of the body or any solid part, 
is affected, the pus has no means of escape. Such an 
accumulation of pus is known as an abscess, and 
unless an opening is made to afford free drainage 
for the imprisoned matter it remains as a menace 
to life. 

Sometimes an abscess is left to burst spontaneously, 

Abscess and if the body is in good general condition, it will 

and blood- J ° ° 

poisoning absorb the poison and throw it out of the system. But 
there is always great danger of blood poisoning, and 
even if the person escapes such consequences, and there 
seems to be a speedy recovery, the possibility remains 
that the poisonous matter has not been entirely evacu- 
ated and that what is left will be sufficient to set up 
further irritation and cause a repetition of the same 
conditions. 

For this reason it is plain that an abscess which has 
Serious- not had free drainage, even when its immediate con- 
an S ab°scess tents have disposed of themselves, needs to be cleared 
out and thoroughly purified before health can be as- 
sured. If an abscess in either the pelvic or abdominal 
cavity is neglected, the consequences are very liable to 
be fatal. When there is severe pain with a throbbing, 
full sensation and increase of temperature attending an 



INFLAMMATION 71 

inflammatory condition, we may be quite sure that pus 
is forming. In severe cases, chills also occur and are 
always to be regarded as a serious symptom. 

TREATMENT FOR INFLAMMATION 

The treatment for inflammation is always to seek 
if possible to remove the cause and to allay the irrita- Removing 

r the cause 

tion that has resulted. Various measures may be 
adopted in order to accomplish this. Both cold appli- 
cations and hot are used in the early stages, some 
doctors preferring the former and some the latter 
method. 

DRY HEAT 

Dry heat is used to increase the temperature of the 
body, whether general or local, to allay inflammation What dry 

, . " , . heat is 

or to encourage suppuration, and to induce free per- used for 
spiration when it is desired to relieve the work of the 
kidneys. Dry heat is less enervating to the tissues than 
moist and there is less danger of taking cold after its 
use. 

"When dry heat is to be employed to induce perspi- 
ration, the patient may be placed on a chair with his Method of 
feet in hot water, the clothing removed and blankets perspira- 
fastened from his neck down around the chair reach- 
ing to the floor. A lighted alcohol lamp is placed in 
a basin underneath the chair, and the patient is kept 
well wrapped up. After sitting thus for a half-hour or 
an hour, free perspiration may be expected to follow, 
and the patient should then be put to bed between 
warm blankets and sponged off with alcohol. Any ar- 
rangement for a hot air bath to be given in bed will 
scarcely be practicable outside the hospital. 



72 



HOME NURSING 



How to 

make a 
hot-water 
bottle 
ready 



HOT-WATER BAGS AND BOTTLES 

Hot-water bags for ordinary use should never be 
filled more than half full, as they are unwieldy if en- 
tirely full. If the bag is held by the handle when rilling, 
rather than by the top, there will not be danger of 
scalding the hand as the water bubbles up from the 
bag. As much air as possible should be expelled from 
the bag before screwing on the top. It is well to form 




Hot- Water Bag 



Bottles 

and bricks man ^ 



the habit of turning a bag upside down after filling, in 
order to be sure that the top is screwed on firmly and 
that there are no leaks. Hot-water bottles are useful 
times where bags are not available. They 
should always be well protected with flannel and 
should not be filled more than two-thirds full, for fear 
of their cracking; for this reason also the corked end 
should always be turned away from the patient. Bricks 



INFLAMMATION 73 

may be used and retain their heat a long time, but they 
are clumsy. 

Flannels for application to any part of the body 
may be kept hot while carrying to the patient, by plac- in appii- 
iiiQ- them in a heated paper or towel. After bein^ hot flan- 

& r l to nels 

put in place they should be coyered with other warm 
flannel or cotton of several thicknesses. 

Bags made of flannel and filled lightly with salt 
or sand can be heated very hot and will remain so for Hot sand 

and salt 

a considerable time. These are useful for earache or in ba s s 
neuralgia of the face. Better for such use is a Japa- 
nese hot box or stove, which can be found in almost any 
place where Japanese goods are sold. It is a little A J a P a - 
metal box slightly curved on one side and having a hot-box 
sliding cover to admit a fuse which when lighted will 
retain its heat for hours. These can be bought in va- 
rious sizes, ranging in price from ten cents upward. 



MOIST HEAT 

Moist heat relaxes the tissues more than the dry. 
By causing the superficial blood-vessels to dilate, it Effect h of^ 
draws the blood to the surface, relieves the conges- 
tion of the more deep-seated vessels, and so eases the 
pain. It is very effectual in hastening suppuration. 

For localized pain, hot compresses (fomentations) 
or poultices are useful. The latter are better if the 
pain is deep-seated. They can be made of any non- 
irritating substance which retains heat well. When 
applied for relief of the deep-seated parts or to hasten 
suppuration, the poultice ought to be large enough to 
cover a considerable surface, but if placed directly 
over a wound it should be only slightly larger than the 
opening. After makingf the poultice it should be taken Applying 

. . , , a poultice 

to the sick-room between two hot plates. It may then 
4 Vol. 3 



74 



HOME NURSING 



When a 
poultice 

should be oftener. 

removed 



be placed in the palm of the hand and carefully slipped 
off on to the inflamed area. By so doing there will 
be no danger of the poultice being applied too hot. 
The skin of a child, an unconscious person or a para- 
lytic is abnormally tender and may be blistered by an 
application that would produce no such effect upon a 
healthy adult. After the poultice has been applied, it 
should be covered with flannel and oiled silk, rubber 
tissue or enamel cloth to help retain the heat longer. 

A poultice of ordinary size will keep warm several 
hours, but a small thin one will need to be changed 
It must never be allowed to become hard and 
dry, nor should poulticing be long continued, as it may 
defeat the purpose for which it was applied, by water- 
soaking the tissues. If no directions are given as to 
the length of time a poultice is to be continued when 
one has been ordered by the doctor, he should be 
asked in regard to it. 



HOW TO MAKE A POULTICE 



To make 
a linseed 
poultice 



Linseed meal is perhaps the most common sub- 
stance used for the making of poultices. To make a 
linseed poultice stir the meal slowly into a saucepan 
of boiling water ^nd let it boil two or three minutes, 
stirring all the time. It should be thick enough when 
taken off the fire to be beaten well with a spoon, in 
order to remove all lumps, and introduce enough air 
to make it light. This is a very important part of the 
process, as otherwise the poultice will not have the 
proper consistency. When finished, it should be light 
and smooth and just thick enough to be cut with a 
knife. Sometimes a linseed poultice is made with an 
antiseptic solution instead of water, and is applied over 
a discharging wound. 



INFLAMMATION 75 

A bread poultice is made by pouring boiling water 
over slices of bread, from which the crusts have been To make 
cut. When thoroughly soaked, the water is drained poultice 
off, the softened bread is beaten well and spread. 
These retain their heat only a short time. 

Dough which has just been mixed is sometimes 
used as a poultice. It is not necessary that it should JJjJJitice 
be raised at all, as the heat of the body will do that. 

Starch makes a soothing poultice and is sometimes 
prescribed in diseases of the skin. It is made by mixing s ^ a J5- h 
the starch with a little cold water and adding boiling 
water to make a thick paste. 

A hop poultice is made by filling a thin bag loosely Hop 

. , , , , ._, poultice 

with hops and wringing it out in hot water. Bran 
may also be treated in the same way. 

A mustard poultice is made by adding to a linseed 
or flaxseed poultice one part of mustard to six of the Mustard 
meal. A good substitute for a mustard poultice is 
said to be a clean flat sponge which has been dipped 
into mustard paste. If this is covered with a thin piece 
of cloth and applied, it can be removed by moistening 
the sponge with warm water. 

A spice poultice is made by mixing a teaspoon 
each of mustard, ginger, black pepper, cinnamon, Spice 
cloves, and allspice together, " and adding hot water 
little by little until the mass is of the consistency of 
putty. This may be left in place all night without 
danger of blistering and is a very soothing poultice, 
because of the essential oils contained in the various 
spices. 

FOMENTATIONS 

Fomentations or hot stupes are applications of moist 
heat by means of flannel or flat sponges wrung out in 
pure or medicated hot water. This means of applying 



76 



HOME NURSING 



Fermenta- heat is pleasanter and simpler than the use of poultices, 
stupes but it is necessary that the cloths be changed as often 
as every ten or fifteen minutes if the treatment is to 
be effectual. Unless constant attention is'-given to their 
application, they have no value. They must never be 
left to get cold. 

Two pieces of coarse flannel are better than one. 
Wringing These are dipped in scalding water, wrung out as dry 
as possible and quickly applied. A cloth which is cool 
enough to be wrung out with the hands can do very 
little good. A stupe-wringer, such as is used in every 
hospital, is a very convenient article to have in the 




A Stupe Wringer 



Conven- 
ience in 
manipu- 
lation 



household and is perfectly simple to make. It consists 
of a stout piece of crash or ticking eighteen by fifteen 
inches, with a stick or small rod run through a hem 
at either end. In place of this a strong towel may be 
used, though it is less convenient, and the hands are 
apt to get burned if there are no sticks to use in twist- 
ing. 

It is a good plan, when stupes are being used, to 
have two basins, one containing the hot water and an- 
other in which to lay the wet stupe-wringer. Two 
stupe cloths are necessary, so that one need not be re- 
moved until the other is ready to put on. The stupe 
is picked out of the hot water and laid in the centre 
of the stupe-wringer or towel and the ends twisted 
tightly. 



INFLAMMATION 77 

After the stupe is in place it should be covered with 
a drv flannel or thick laver of cotton batting and oiled Necessary 

° precautions 

muslin be placed on top of that. The first few stupes 
that are used can not be borne as hot as they can be 
later. Care must be taken not to allow the patient's 
nightdress to become damp, and it is well to place a 
piece of rubber cloth or folded newspaper over the 
mattress to prevent any dampness, though if the cloths 
are wrung dry, as they should be, there will be no pos- 
sibility of their dripping. 

After stupes are discontinued, a dry flannel should 
be kept over the part as protection for a while. 

If turpentine stupes are ordered and no special di- 
rections are .given for their application, one part of Ju P cs ntine 
turpentine may be mixed with one of oil or vaseline, 
warmed and rubbed over the surface to be treated, and 
plain hot-water stupes applied. This method prevents 
irritation to the skin from the use of the turpentine. 

When small compresses are used for the eye or any 
part of the face, they can be wrung out in a lemon 
squeezer. 

A breast compress should be made with a small 
hole in the centre to admit the nipple, which should J mpress St 
never be covered. 

COLD APPLICATIONS 

In the earlier stages of inflammation, either cold 
or hot compresses may be prescribed, according to the 
preference of the physician, as both are useful in re- 
ducing inflammation, though heat must be used with 
caution, on account of its tendency to induce suppura- 
tion. Heat and cold have an opposite effect upon the Effect of 

i 1 j T-i i-i « c °ld on 

blood-vessels. I he one dilates the superficial vessels, as lhe b lood 

. vessels 

we have already said, and thus relieves the congestion 
of the deeper parts, while the other contracts them and 



78 



HOME NURSING 



Ice bags 
to fit 
different 
parts of 
the body 



sends an excess of blood to the deeper vessels, which 
in their turn react and force the blood again to the 
surface, thus establishing a better circulation through- 
out the tissues. 

Cold compresses are usually changed hourly or once 
in two or three hours, according to the amount of in- 
flammation. 

The ice-bag now in general use furnishes a very 
effectual way of applying cold. Besides the ordinary 
round bags with metal screw top, they can be bought 
of various shapes to fit the different parts of the body. 





Rubber Ice-Pags 



There are the helmet-shaped ones for the head, which 
can be tied in place, and the long, narrow ones, which 
are useful for the neck and spine. One of the most sat- 
isfactory bags, because of its slight cost and conven- 
ience in handling, is made of rubber tissue and has no 
cover. The top is firmly tied with a piece of tape, so 
that the water from the melted ice does not escape. 
These come in various sizes and are lighter and less 
clumsy than other bags. 

If there are no better facilities for cracking ice it 
can be placed in a stout cloth and pounded. In filling 



INFLAMMATION 79 

the bag, one should be careful not to drop in sharp 
pieces heavily, which might pierce a hole in it. The 
bas: should not be more than half filled with ice and the Preparing 

& the ice 

air must be excluded, as in filling a hot-water bag, be- 
fore the cover is put on. A small piece of gauze or a 
handkerchief should always be placed between the ice 
bag and the skin, as otherwise there might be danger 
of "frost-bite." If the surface of the skin shows any 
spot that is deep red or purplish at any time during Guard_ 
the continued use of an ice bag, it is an indication that frost bite 
the ice is irritating the skin, and it should be taken 
off. A bag for the head can be wrapped in a thin 
cloth and pinned to the pillow, so that the weight may 
be somewhat lifted from the patient's head. 

ICE-COILS 

Ice-coils are also used extensively for inflammatory 
conditions. They consist of rubber or lead tubing, 
made into a coil with a yard or two of the tubing 
left at each end, so that a siphon can be made. A 
large pan of ice water must be arranged to stand above Arrange- 
the patient's head, with one end of the tubing placed ice - coil 
in it and fastened to the side of the pan with adhesive 
plaster, so that it can not slip, but loosely so that there 
will be no obstruction to the flow of the water. The 
coil is then put in place, and the other end of the 
tube allowed to rest in a pail or foot-tub, which is 
placed near the bed to receive the water. A piece of 
tape tied round the upper tube serves . to retard the 
stream of water, which should be regulated until it 
drops very slowly from the end of the tube. There 
may be some difficulty in starting the flow of the 
water, but by pinching the tube to give suction it can 
be done. It is better not to tie the regulating tape 



80 



HOME NURSING 



Effect of 
counter- 
irritants 



Fomenta- 
tions and 
poultices 



Mustard 
paste 



The after 
oiling and 
covering 
the skin 



until the stream has been induced to flow freely. If 
there is no ice-coil available, one can be made by sew- 
ing rubber tubing in the form of a coil upon a piece of 
cloth. 

COUNTER-IRRITANTS 

Counter-irritants are remedial agents applied to 
produce dilatation of the superficial blood-vessels and 
contraction of those in some adjacent or deep-seated 
part of the body, probably through reflex action of the 
nerve endings. 

Fomentations and poultices are regarded as mild 
counter-irritants. Counter-irritants are often applied 
to places remote from the seat of the pain as when a 
mustard foot-tub is used to relieve a congested state 
of the head or abdomen. Mustard is one of the most 
common substances used to produce counter-irritation. 
Mustard paste, which is more rapid in its action and 
more irritating than a mustard poultice, is made by 
mixing flour with the mustard in different proportions. 
The ordinary formula is one part of mustard to six of 
flour. This is rubbed into a paste with a little cold 
water and spread between two pieces of cloth. It 
should not be kept on longer than twenty minutes, and 
as some skins are more sensitive than others, it should 
be watched closely and removed before that if nec- 
essary. With unconscious patients the application must 
be closely watched. 

After the plaster has been taken off, the surface of 
the skin should be oiled and covered with a soft piece 
of muslin. Tepid water should always be used to mix 
the mustard, as hot water or vinegar robs it of its 
full strength. If the plaster is to be used on a child, 
one-third glycerine should be added to the water used 
for mixing or the proportion of mustard should be 
reduced by one-half. 



INFLAMMATION . 81 

Mustard leaves are small sheets of paper covered 
with a mustard preparation put up in a tin box and 
obtainable at any large drug store. If these are used 
they have only to be dipped in tepid water and applied. 
A thin piece of gauze or muslin placed between the 
mustard leaves and the skin renders its effect more 
gradual. 

A cayenne pepper plaster can be made by mixing Cayenne 
a tablespoon of cayenne with flour and water to form piaster 
a thin paste. 

Iodine is a counter-irritant in very general use. 
The external skin or mucous membrane is painted with iodine 
it, using a camel's-hair brush or cotton swab for its 
application. More than two coatings will be apt to 
blister the surface. If the skin becomes too much ir- 
ritated, sponging with alcohol will relieve the smart- 
ing. 

For lumbago or sciatica the use of a hot flatiron, 
which is passed over the surface protected with twoAg n 
or three thicknesses of flannel, often gives great relief, 
particularly if warm turpentine and oil in equal parts 
has first been rubbed over the affected part. 

Sometimes it is thought necessary to stimulate 
rapidly, as in condition of shock, and aqua ammonia is Aqua 
ordered as a counter-irritant. A piece of gauze or cot- 
ton wet in the solution is applied and covered close with 
oiled silk. This is left on five or ten minutes. Chloro- 
form is also used in the same way. 

Croton oil is such a strong irritant as to produce an 
eruption. It is often diluted with an equal amount of Croton oil 
olive oil and a very little of it is rubbed into the sur- 
face with a piece of flannel at intervals of four or five 
hours till the eruption appears. 

The practice of cupping, though somewhat out of 
date, is still used for the relief of pain or labored 



ammonia 



82 



HOME NURSING 



The prac- 
tice of 
cupping 



The 
method 



breathing, but it should not be attempted by unskilled 
hands. To prepare for dry cupping it will be necessary 
to have a spirit lamp, alcohol, a glass or metal rod or 
stiff wire, absorbent cotton, and five or six wine or 
medicine glasses, unless the regular cupping set is avail- 
able. 

The inside of the cups are heated by the aid of these 
appliances in such a way that when the cups are rapid- 
ly applied to the surface to be treated and held down 
firmly for an instant, a partial vacuum is formed in 
cooling, the skin is sucked up to fill it, and the blood 
is consequently drawn to the surface. In removing the 
cups, which adhere closely, the flesh near the rim of 
each cup is pressed down to admit the air, and the cup 
can then be lifted easily. 

The process of wet cupping, which is always done 
by the physician, is much the same, except that the skin 
is first scarified before the cups are applied. 

Leeches are very seldom used in this country, as 
wet cupping answers the same purpose. 



bing and 
variations 



MASSAGE 

It is quite impossible to attempt any exposition of 
Simple rub- scientific massage without practical demonstration. 
There are, however, several variations of simple rub- 
bing suggested by the massage movements which are 
perfectly possible to untrained hands and prove their 
usefulness by the relief they give. 

Tired backs are soothed by a gentle pounding mo- 
tion with the lightly clinched hands, alternating one 
with the other over the soft parts, always avoiding the 
bones of the spine. This may be followed by a soft pat- 
ting with the palms of the hands and light rapid strokes 
extending from the neck to the base of the spine and 
repeated for several times. The circular motion with 



Soothing 
tired backs 



INFLAMMATION 83 

the palm, keeping the fingers together and the hand 
steady so that it stirs the deeper tissues under it in- 
stead of moving lightly over the surface, is often very 
restful. The inclination of one entirely unfamiliar 
with massage, is to rub up and down the back without 
taking the hand off, as if using a flatiron, whereas 
passing the hand over the surface in this same circu- 
lar motion will generally be more effective. 

Regular massage given by a skilled operator is 
very useful in many nervous disorders and in joint af- After- 

' . a r i i -■ . effects 

fections. After a general massage the temperature is of the 
usually found to have increased about a degree, and 
there should be entire rest for an hour afterward in 
order to get the full benefit of the treatment. 

Sometimes the massage, instead of having a seda- 
tive effect upon the nerves, seems to have quite the op- 
posite, but in general the effect is a soothing one and 
for this reason it is often very helpful in cases of 
insomnia. 

The head massage is simple and sometimes gives 
considerable relief in cases of severe headache. It also Head 

massage 

serves as a most useful remedy for dandruff and fall- and ,i ts 

J t results 

ing out of the hair, because it stimulates the scalp and 
causes new growth to appear. In the latter case it 
must be used faithfully once, or better still twice, a 
day for weeks before there is any evidence of improve- 
ment. A little vaseline rubbed into the roots of the 
hair at the same time tends to increase its growth. 

When massage is to be given it is necessary to take 
a position behind one's patient, and placing the hands Method 

. of head 

on opposite sides of the head, compress it gently and massage 
give semi-rotary motion to the scalp, which will move 
freely under the hand. The hands may be moved 
from time to time so as to include each portion of the 
head till the whole has been treated. One hand may 



&t HOME NURSING 

be placed on the forehead and the other at the base of 
the head and pressure with the same circular motion 
applied. Beginning with the back of the head and 
keeping one hand firmly on the forehead stroke down- 
ward with the other in a V shape, gently pinching the 
flesh in the nape of the neck. In stroking the fore- 
head, place the thumbs between the eyebrows and 
stroke firmly over the temples to the ears, both thumbs 
working. together so as to act upon the nerves around 
the orbits of the eyes. Friction and kneading of the 
neck are of the greatest benefit. 

For facial massage, make upward and outward 
Facial circular movements with the tips of the fingers and 

massage r & 

do not reverse. 

THE GIVING OF MEDICINES 

Medicines may be introduced into the system in 
How medi- various ways, the most common, of course, being 

cines are i , , t i . ,_, 

given through absorption in the alimentary canal. Ihe most 
rapid absorption is gained when medicines are in- 
jected into the tissues under the skin. Medicine may 
also gain entrance through the rectum, through the 
skin, and through the lungs by means of inhalation. 
Medicines taken by mouth are absorbed in the stomach 
and, to some extent, in the intestines. They are given 
in the form of solutions, powders, pills, capsules, or 
tablets. Solutions should always be well shaken and the 
dose poured into a small glass and diluted according 
to direction. 

If no directions are given, dilute as little as possi- 
ble. A large amount of water added to a disagreeable 
dose often makes it harder to take and more nauseat- 
ing. Its action also is naturally retarded by too great 

To take dilution. A bit of ice held in the mouth before taking 

unpleasant 

doses a bad dose dulls the nerve of taste, rendering the taste 



INFLAMMATION 85 

less unpleasant. If the nose is held while the dose is 
being taken and it is placed far back in the throat and 
the mouth is held open a moment afterward, the dose 
will not be found very disagreeable. Many offensive 
doses are now given in capsules and taken like pills. 
They may often be thrown into the throat and carried 
down with a quick swallow of water. 

Sometimes, especially in the case of children, the 
pill may be concealed in a spoonful of jelly or custard Concealing 
or it may be crushed and given as a powder. Bitter or P a P er 
powders may be inclosed in rice paper wafers which 
come in boxes prepared for such use. A moistened 
wafer is first laid on a teaspoon, the powder placed in 
its centre and another wafer folded over it. The 
spoon is now filled with water and the whole placed 
on the tongue and taken with a drink of water. If 
pills have become hardened with age, they may pass 
through the body undissolved and so are worthless. 

Castor oil if not given in capsule form may be 
sandwiched between two lavers of sherry, strong cof- To take. 

. . ' castor oil 

fee or orange-juice. The sherry is first placed in the 
medicine glass, the rim and sides of which have been 
moistened with it, the oil is then carefully dropped into 
the centre without allowing it to touch the sides of the 
glass, more sherry is added and the dose is prepared. 
This can be taken in one swallow, and if carefully made 
ready, there will be no flavor of the oil left in the 
mouth after taking it. 

HYPODERMIC INJECTIONS 

A drug which requires fifteen or twenty minutes 
to act if given by mouth will usually be absorbed in ^ . , 

r • • r • Quickness 

five minutes if given by hypodermic injection. 'Mor- °. f absorp- 
. . . tlon °f the 

prune is commonly given in this way on account of dose 

its bad effect upon the stomach. Brandy, whiskey, 



86 HOME NURSING 

or ether are also given by hypodermic injection when 
rapid stimulation is necessary. 

It sometimes happens that in the course of a pro- 
Surgicai tracted disease a member of the family must be de- 

cleanlmess . .... 

necessary pended upon to give hypodermic injections, and it 

should never be done carelessly. The principles of 

surgical cleanliness must be observed each time if 

abscess formation is to be avoided. Both solution 

and syringe must be as nearly sterile as it is possible 

to make them, and the skin thoroughly cleansed with 

pure alcohol before the needle is inserted. The 

sterilizing needle is sometimes sterilized by being passed through 

of hypo- an alcoholic flame just before inserting, but this 

syringe method dulls the needle and makes its insertion more 




Hypodermic Syringe of Glass and Asbestos 

painful. The best method is to boil the needle for a 
minute. This can be done in a tablespoon of water 
over an alcohol or gas flame. It is not necessary to 
touch the needle itself in screwing it into the barrel 
of the syringe if one is careful in doing it. 

The barrel of the syringe can be sterilized by draw- 
Steriiizing ingf through it several times pure alcohol followed 

the barrel , , ., , 

by boiled water. 

A comparatively new hypodermic syringe which 
can be boiled entire is now on the market. It is made 
wholly of glass with asbestos packing. 

If the needle is in frequent use it may be kept in 
a strong solution of carbolic acid and carefully 
washed off with boiled water before using. 

' When the skin has been cleansed, either on the 
outer fleshy part of the arm or leg, and the syringe 



CARE OF MEDICINES 87 

is ready for use, the air should be expelled from it 

bv pointing: the needle upward and gently pressing: How to 

P . . gi v e the 

the piston till a drop of the solution appears at the hypo-, 
point. A small fold of skin is then pinched up be- injection 
tween the thumb and finger of the left hand, and the 
needle quickly inserted for at least half an inch, in a 
slanting direction, and then withdrawn very slightly 
in order that the fluid may flow more easily. The 
fluid should be injected slowly, the needle then quickly 
drawn out and the thumb placed over the spot for a 
moment to prevent the escape of any of the medicine. 
A hypodermic injection must never be given over 
a bon\' prominence or in the region of the large 
blood-vessels, as serious results have been known to 
follow the introduction of a solution into a vein. 



CARE OF MEDICINES 

[Medicine bottles need to be distinctly labeled and 
those containing poison especially marked to indicate Label 
the fact. A bow of ribbon may be tied round the medicine 
neck of a bottle to distinguish it if no means of 
labeling is at hand. All medicines intended only for 
external use should be kept by themselves on a shelf 
separate from the others and never within the reach 
of children. The medicine closet should always be 
kept locked and should be in a dry, cool place. 

When medicine is being poured from the bottle, 
the label should be kept on the upper side, so that Precaution 

1 L * in pour- 

it may not become defaced. A medicine should never ing out 

■* medicines 

be poured from the bottle till the label has first been 
looked at. Such a precaution prevents the possibility 
of a mistake being made, and the habit of glancing 
always at the label is very easily formed. One is 
never sure that the bottles may not have been dis- 



88 v HOME NURSING 

arranged. No medicine should be poured out in the 
dark : always have full, bright light. 

It is a great mistake to keep medicines on hand, 
Never as many of them spoil easily, and either become 

use old , 1 J F , r , 

medicines worthless or are so concentrated from long standing 
that they are no longer safe to use. There ought to 
be a frequent overhauling of the medicine closet, and 
all prescriptions the use of which has been discon- 
tinued should be thrown away. All bottles should 
have corks and be kept closely covered. 

It is a temptation for one who has observed a 
Never pre- good many cases to suggest remedies which she 
another, knows to have been useful to others. This habit, 
however, is never a safe one to indulge in, and the 
more actual knowledge one gains upon the subject 
of the action of drugs and their varied effects on 
different constitutions, the less willing is one to yield 
to the temptation of prescribing. 

It is important that medicines be given regularly 
Prompt- and promptly. If there are no special orders given, 
regularity a half-hour may be allowed between medicine and 

in giving 

medicines food. Most drugs act more powerfully on an empty 
stomach than on a full one, though medicines which 
are apt to produce nausea, as cod-liver oil, are given 
after eating. Both spoon and glass should be washed 
each time after using and a separate glass kept for 
strong-smelling medicines. 

In giving medicine to an unconscious patient, if 

Medicines the lips are moistened first and rubbed lightly with 

to an un- r ° J 

conscious the spoon, he can often be made to swallow. In the 

patient r ' 

case of a baby the spoon should be held a moment 
between the teeth and the child will be obliged to 
swallow. 

The use of patent medicines is deplorable. Their 
apparent power is generally due either to the action 



CARE OF MEDICINES 89 

of some powerful narcotic or to a very large per- 
centage of alcohol, and in either case the temporary Don 't use 

,.,',. . patent 

relief which they give only conceals the real condi- medicines 
tion or progress of disease and the person is left far 
worse off than before taking them. 



VI 



CARE OF OPERATIVE CASES 

Preparation for Operation— Emergency Preparation— Preparation of Patient 
—Full Preparation for Operation— The Anaesthetic— Assisting the Surgeon 
—After-care of Patient— The Problem of Food— Cases of Minor Sur- 
gery—Convalescence 

PREPARATION FOR OPERATION 

THE need of a surgical operation to be performed 
in the home is a possibility in any family, and 
it is quite natural that the responsibility of prepara- 
tion 'in 6 ™' ti° n should bewilder one not accustomed to such an 
the home undertaking. 

The mention of the word operation at once sug- 
gests the amazing knowledge the surgical world has 
gained in regard to the treatment of wounds and the 
precautions necessary even in dealing with minor 
surgery. 

Two words in common use among doctors and 
Asepsis nurses may need explanation. They are asepsis and 
sepsi antl " antisepsis. The former indicates a condition of sur- 
gical cleanliness or, in other words, a thing which is 
said to be aseptic has been rendered not only free 
from ordinary dirt, but free, so far as it is possible 
to make it, through various means, from any trace 
of poison-bearing germs. The latter term — antisep- 
sis — refers to the means used to destroy microbes 
found either in a wound or upon the hands of the 
operator or on articles which might come in contact 
with the wound. 

There is a notable distinction between ordinary 
cleanliness and surgical cleanliness, which must be 
(90) 



CARE OF OPERATIVE CASES 91 

borne in mind by all who assist in preparing for an 
operation, and one's effort must be always toward 
aseptic conditions so far as it is possible throughout 
the preparation and after-care of surgical cases. 

EMERGENCY PREPARATION 
It often happens that the need of operation is so 
imperative as to demand the immediate work of the what 

. to do 

surgeon, and in such a case it mav be valuable to before the 

. ' . surgeon 

know what is absolutely essential in the way of the arrives 
preparation which has to be hastily made. There is 
usually the lapse of a couple of hours, if not more, 
before the surgeon arrives with instruments and dress- 
ings, and in that time much can be accomplished. 
There will be need of plenty of boiled water, both 
hot and cold, and large kettles should be placed on 
the stove at once and the water allowed to boil 
twenty minutes. The water should cool in the vessel 
in which it has been boiled, and it must be closelv Bo j led 

* J water 

covered and remain so until it is needed, when it can 
either be poured into the proper receptacles or taken 
out with a utensil which has also been boiled and 
rendered sterile. 

The room chosen for the operation should yield 
the best possible light, and it is far better not to 
remove hangings from the windows, for fear of fill- 
ing the air with dust particles. They can be covered 
if there is time with sheets, and the carpet, particu- ^| e S u ^? wn 
larly where the table is to stand, may be covered with Wlth sheets 
heavy manila paper or old sheets tacked down firmly. 

The kitchen table usually furnishes the best sub- 
stitute for an operating table, and it should be covered Prepara- 

. . tl0n of 

first with several thicknesses of blankets, then with the kitchen 

' table 

a rubber sheet and a cotton one, all securely pinned 
underneath, so that they will not be in the way. A 



92 



HOME NURSING 



Small 
tables, 
stool, 
foot-tub, 
and bowl 



Position 
of the 
operating 
table 



Sterilizing 
basins 
for the 
solutions 



Treatment 
of china 
pitchers 



flat pillow should be placed where the head is to rest, 
and if nothing better offers this can be fashioned out 
of a small blanket slipped into a pillow-case. 

The only other furniture in the room will be two 
small tables for the solutions, instruments, and dress- 
ings, a commode or table for the surgeon's use in 
scrubbing up unless there is a bathroom adjoining, 
and a stool for him if he wishes it. A piano-stool 
may be made use of, and if it is upholstered should 
be covered with a towel neatly pinned into place. A 
large pail or foot-tub is necessary to receive the soiled 
pieces of gauze or cotton used during the operation, 
and a bowl or pail large enough to hold a solution for 
rinsing the hands from time to time should be placed 
on a chair or stool within reach of the surgeon. 

The operating table should be placed near the 
window, and all the light possible must be admitted. 
Bon ami or sapolio smeared over the panes makes 
them opaque and yet does not exclude the light as a 
curtain would do. 

For the arrangement of the various articles in the 
room the accompanying sketch may be suggestive. 

If it is possible to get two new enamel basins to 
hold the solutions it is the better plan, as they can so 
easily be sterilized. After a thorough scrubbing with 
sapolio and plenty of hot water, they should be rinsed 
and dried, a spoonful of alcohol placed in each, being 
particular to wet the sides of the basins with it, and a 
lighted match applied. This must be done carefully 
and in a suitable place, so that there will be no danger 
from the flames. When the dishes are cool they can 
be lifted into place, always remembering that the 
fingers must not touch the inside, which has been 
made sterile. China pitchers and bowls will probably 
have to serve as receptacles for the supply of water 



CARE OF OPERATIVE CASES 



93 




94 HOME NURSING 

sterilizing and since they can not be treated in this way they 
must be carefully scrubbed and rinsed with some anti- 
septic solution followed by boiled water. 

The surgeon will doubtless bring his own supply 

of sterilized towels and dressings, which he will take 

charge of himself, but it is always safer to provide 

unsterilized towels, which can be wrung out in an 

antiseptic solution and used if necessary. Two dozen 

of these should be furnished, but it is not essential 

that they be fine-face towels. Clean sanitary napkins 

or dish-towels answer the purpose quite as well. 

Plenty of alcohol, bichloride tablets, carbolic acid, 

other and brandy should be on hand, and a clean brush for 

in the the surgeon's nails. Safety-pins and bandages will 

operation ^ e neQ ded. An abdominal bandage can be made of 

three yards of white cheesecloth doubled and folded 

the required width. 

The room should be kept at a temperature of 70° 
Tempera- F. unless an abdominal operation is to be performed, 

ture of ...... . .. 

the room in which case it will be necessary to have the tem- 
perature remain at 8o° F. 

THE PREPARATION OF THE PATIENT 

The preparation of the patient will be very little 

Bodily beyond putting on a fresh nightdress and stockings, 

ituai treat- which are better white than black. The hair, if not 

"/"lie already so arranged, should be plaited in two braids. 

patient All food -and water must be withheld. Everything 

possible should be done to inspire the patient with a 

quiet and hopeful attitude of mind, and no trace of 

excitement or nervous tremor should be observed in 

the sick-room. On no account should the patient be 

a witness of any of the preparations. 

The anaesthetic will be given before the patient is 
moved into the operating-room, and it is not neces- 



CARE OF OPERATIVE CASES 95 

sary that there should ever be any knowledge of the 
appearance of that room. The patient should void Before 
urine the last thing before the anaesthetic is admin- anaesthetic 
istered. If there are false teeth they must be removed, 
as accidents have been known to occur from their 
being left in while a patient was unconscious. Be- 
fore being moved into the operating-room the patient 
should be covered with a light blanket carefully ar- 
ranged to avoid exposure. 

FULL PREPARATION FOR OPERATION 
All of this preparation can be done in the short 
time allotted if it is undertaken quietly and system- More 
atically. If, however, an operation is to take place pre para- 
at some future date, a more careful preparation of tl0ns 
the room and patient can be given. In such a case 
the room should be thoroughly cleaned and aired, the 
hangings and carpet removed, the walls brushed 
down, and the floor scrubbed and washed with a 
bichloride solution. The further preparation would 
remain about the same as above except that it would ?.? . ster " 

r llizing 

be possible to sterilize towels. Packages of these towels 
should be done up in two covers of muslin and steril- 
ized according to the directions for sterilization given 
in Chapter III of Part II. They should not be 
sterilized earlier than the day before the operation. 

The preparation of the patient, unless special con- 
ditions exist, consist of a thorough evacuation of P/epara- 
the bowels by means of a cathartic if the doctor ap- the patient 
proves, followed by enemata till the water comes clear, 
and a cleansing bath the night before the operation. 
After the enemata nothing should be given in the 
way of food except beef tea or malted milk, and all 
nourishment must be withheld for at least three hours 
before the operation. 



96 



HOME NURSING' 



To make 
an ether 
cone 



Guard 
against 
inflam- 
mable 
character 
of ether 



When one 
of the 
family- 
assists 



THE ANESTHETIC 

It is customary for the surgeon to provide the 
anaesthetic. If ether is to be administered and there 
is no inhaler used, an ether cone can readily be made 
by folding two or three thicknesses of newspaper to- 
gether to make a pad about sixteen inches long by 
nine inches wide and covering this entirely with a 
piece of loosely woven toweling. This pad can then 
be twisted into the shape of a cone and pinned with 
a small opening left at the top. A bit of absorbent 
cotton can be put inside to receive the ether. 

If the operation is at night and ether is used, it 
is well to bear in mind the inflammable character of 
the fumes. Ether fumes are heavier than air, and the 
lights should be kept above the region of the can or 
inhaler. 

When chloroform is used as an anaesthetic it is 
usual to apply vaseline over the lips and nose to pre- 
vent irritation from the vapor. During the time that 
the patient is getting under the influence of the anaes- 
thetic it may be necessary that some one of the family 
be in the room to give some assistance if the patient 
is inclined to struggle, and considerable anxiety may 
be removed if one realizes something of the natural 
effect to be expected from an anaesthetic. The quick- 
ened breathing and deeply flushed face need not cause 
any alarm, as it does not indicate distress. 



ASSISTING THE SURGEON 

During the operation it will seldom be necessary 
for one of the family to be present, as in almost all 
cases the surgeon brings his own assistants. If, how- 
ever, conditions require it, the duties will doubtless 
be very simple and will consist of nothing more than 



CARE OF OPERATIVE CASES 97 

the explicit following of the doctor's orders. A cool Explicit 

, , . t . , . follow- 

head, close attention to directions, and strict care not j ng f 
to touch dressings or instruments are all the re- ^^l s 
quirements that are necessary for such a trying 
experience. 

If, as is altogether probable, there will have to be 
moments or even hours of intense anxiety outside a 
closed door, the alternative is a difficult one. It is 
well to provide one's self with some work which de- Contro1 

r . . anxieties 

mands concentration, because it is always possible to by work 
keep the mind better controlled if the hands are occu- 
pied. 

The first thing, however, to be attended to will 
be the preparation of the patient's bed. The only Special 

r i- 'iiii -11 1 needs of 

variation from an ordinary sick-bed that will be patient's 
necessary is the placing of a blanket in the bed and precau"* 1 
several hot-water bag's. There should be at least four tion . s 

against 

bags provided if the case is an abdominal one, and heat 
extreme care must be taken not to have them too hot. 
Frightful burning accidents from contact with hot- 
water bags have occurred in the case of unconscious 
patients, and it must never be forgotten that the 
lowered vitality of an ether patient produces an ab- 
normally sensitive condition. The method of holding 
the bag to the cheek a moment in order to test its 
heat before putting it into the bed is always a safe 
one. One bag should be filled only half full and may 
be laid over the heart to stimulate its action. Heat 
should never be applied directly over or in the region 
of the operation, as there is danger of its producing 
hemorrhage from the sudden expansion of the blood- 
vessels. 

The pillow should be a low one, preferably of 
hair, and a towel should be laid over the pillow-case. £J2JJ and 

Two basins and gauze or towels for wiping the 
5 Vol. 3 



98 HOME NURSING 

mouth are to be placed on a table near the bed, for 
vomiting is almost sure to follow the anaesthetic. 

AFTER-CARE OF THE PATIENT 

After the patient is returned to the sick-room he 
must not be left a moment until consciousness is en- 
tirely regained. Ether affects persons very differ- 
The com- ently. With some the unconsciousness and relaxation 
oTthe are profound and the awakening from it is like that 
patient from a deep sleep. With others the mind seems more 
disturbed and there is constant groaning and often 
excited talking as the effect of the anaesthetic wears 
off. It will be found, however, that there is no re- 
membrance later of distress of mind or body, and if 
this can be borne in mind the strain on the one at- 
tending will be much less great. 

If there is continued nausea or vomiting it may 
Nausea De relieved by giving bits of cracked ice to hold in 

and food °. , ~ 

the mouth or a little black coffee may serve to settle 
the stomach. Sometimes the fumes of acetic acid 
(vinegar) relieve the feeling of nausea or a cold com- 
press over the throat may do the same. After an 
abdominal operation nothing should be given without 
the doctor's knowledge, and he will wish to leave ex- 
plicit orders as to the times and quantity of the feed- 
ings, which must be very cautiously regulated. The 
patient will probably express alarm lest the effort of 
vomiting break open the wound, but there is almost 
no chance of such a possibility, as the surgeon always 
bears in mind this additional strain and strengthens 
the wound accordingly. 

Surgeons differ in regard to the time when ab- 

Tuming dominal cases may be turned, some regarding it 

essential that the patient should remain on the back 

for twenty-four or even thirty-six hours, while others 



CARE OF OPERATIVE CASES 99 

allow their patients after six hours to be turned a 
little on the side with a pillow at the back. 

It is impossible to give full instructions in regard 
to the care of abdominal cases, since so much de- Need of 

..' . r 1 i • a special- 

pends upon the condition of the patient, and it is very i s t the 
necessary that one who thoroughly understands the first week 
nursing of such cases should have the responsibility 
for the first week at least. 

The knee pillow is useful to relieve the strain upon 
the abdominal wall, and a small pillow that can be ^[j^, 
easily turned is much more comfortable for the head 
than a large and thick feather one. 

The gas pains, which are often very severe, may 
begin to be felt during- the first twelve hours. The Relieving 

° . gas pains 

soft rubber rectal tube inserted and moved about in 
the rectum may bring away some of the gas and give 
immediate relief, though it is hardly to be expected 
so soon after the operation that the gas will be suffi- 
ciently low in the bowel to be reached by the tube. 
Gas pains indicate the activity of the bowels, and are 
looked for as a sign that all is going well. At the 
end of twenty-four hours, if the gas is not passing off 
freely, the doctor will doubtless order a hot saline 
enema to be administered high, using the soft rubber 
tube. He may remain himself to give the first 
enema, but if not some assistance will be needed in 
giving it, as it is never wise to attempt it alone while 
the patient is so weak and needs to be lifted on to the 
bed-pan. As the bowels become warm with the water 
the gas should begin to pass off. 

It must be remembered that the bowels have been 
thoroughlv emptied before the operation, so that it In difficult 

•11 i r • .i cases 

will not be necessary for the patient to retain the 
water as for an ordinary enema. Sometimes the 
patient is unable on account of weakness to expel 



100 HOME NURSING 

the water, and then it should be returned by inserting 
the long rectal tube. If after several bags of the 
saline enema there has been no gas expelled, the 
patient should rest a while and then the treatment 
should be resumed until successful, as it is very im- 
portant that the gas should not be allowed to collect 
in the bowels. If relief does not come with the use 
of the saline enema, the doctor will probably advise 
some medication to be added. 

With the free escape of gases the patient will 
find great relief, and the abdomen, if it has been at 
all distended, will appear normal again. 

THE PROBLEM OF FOOD 

If there are no complications attending an ab- , 
dominal case, and the wound heals without suppura-, 
tion, the patient will be feeling very comfortable at 
the end of a week and will begin probably to take 
solid food. 

A few days after the operation, if the doctor 

First food allows it, orangeade can be given occasionally and 

few days will be most refreshing if served ice-cold with a dash 

o£ lemon- juice added. If tgg albumen is mixed with 

it, it can be given as nourishment, but the egg should 

not be beaten, simply stirred enough not to be stringy. 

The problem of variety in liquid diet is apt to be 

troublesome, but there is really quite a list to choose 

from if one's attention is directed to it. Milk, of 

Milk course, remains the chief resource if the patient can 

take it. It may be given cold or warm, as preferred, 

and if very rich it can be mixed with seltzer water. 

The old-fashioned gruels made of oatmeal, Indian- 

Grueis meal, flour, rice, and cracker have different degrees 

choked °* usefulness if properly prepared. The first two are 

considered rather too heating for fever cases, and the 



CARE OF OPERATIVE CASES 101 

last are good in cases of diarrhoea. Indian-meal gruel 
is frequently under-cooked, and served in this way is 
not easily digested. It should be cooked four hours, 
and is then delicate and of sweet flavor, quite different 
from the raw unpalatable stuff that is sometimes 
carried to the sick-room. 

The various foods on the market, such as Im- 
perial Granum, Malted Milk, Cereal Milk, and Eskay's Other 
Food, are useful. The latter is one of the newer foods 
and is especially delicate and pleasant. With all of 
these foods the directions are given on the box, 
though in almost all cases the time given for cooking 
is too short and individual taste may suggest some 
variation, such as pouring the hot malted milk upon 
a tablespoon of thick cream, which makes it a most 
delicious drink. 

Koumiss, is enjoyed by some patients, and is di- 
gested by very delicate stomachs when other foods 
are rejected. Fruit egg-nogs, expressed beef -juice, and 
broths help to make variety, and albumen water, while 
not especially palatable, can be taken without distaste 
by most persons. 

The following receipts for invalid cookery may be 
helpful : 

FRUIT EGG-XOG 

One egg, one orange, half a lemon, two to four 
teaspoons of sugar. Beat the yolk of the egg and 
add the orange and lemon juices. Add sugar to the 
white of the egg, and beat until stiff. Combine and 
mix well. Pour upon cracked ice and serve at once. 
Thin slices of banana or a few strawberries may be 
added if desired. 

EXPRESSED BEEF-JUICE 

Take one pound of thick round steak, broil slightly 



102 HOME NURSING 

and place on a hot platter. Cut in small pieces and 
press out the juice by means of a meat-press, lemon- 
squeezer, or potato-ricer. Add a very little salt, and 
serve either ice-cold or warmed by placing the cup 
in hot water a few moments before serving. If heated 
over the fire it will curdle. 

CORN-MEAL GRUEL 

One pint of boiling water, one scant tablespoon of 
Indian-corn meal. Mix the meal with a little cold 
water and stir into the boiling water. Boil for four 
hours. Strain and season with salt. Sugar and cream 
may be added if wished. 

MEAT-BALLS 

Scrape raw beef and mold into tiny balls three- 
quarters of an inch in diameter, with a bit of chopped 
parsley added. Place in a hot pan over the fire, with 
a little butter and seasoning, and keep the pan moving 
until the balls are evenly seared. Serve on bits of 
delicately browned toast. 

PRUNES WITH WINE 

Wash quickly in hot water half a pound of dried 
prunes. Soak overnight. Cover with claret and 
simmer until soft. Add sugar to taste and cook ten 
minutes more. Serve cold. 

CASES OF MINOR SURGERY 

The cases of minor surgery, by which we mean 
those that are not naturally attended with serious re- 
sults, frequently do not require the services of a 
trained nurse, though the nursing demands intelli- 
gent watchfulness and attention to detail in the gen- 
eral care. 

Rectal cases are often treated at home with en- 



CARE OF OPERATIVE CASES 103 

tirely satisfactory results. It must be expected that 
there will be great suffering unless the doctor ap- Precaution 
proves of the use of morphine, which is usually given JJJ 0V ^ of 
at first to such cases if treated in the hospital, because |^J£" 
a very large number of nerve-endings have to be ex- 
posed by the operation. The removal of hemorrhoids, 
while not regarded as a difficult operation, is yet one 
that demands the utmost skill. Very alarming nerv- 
ous disorders sometimes follow if too large an area 
of the mucous membrane is interfered with, and too 
great a number of nerves are exposed. This all goes 
to show that even minor cases require the work of a 
skilled operator, and a choice should not be made 
without careful consideration and advice. If this 
precaution is observed there need be little fear of the 
ultimate result not being successful. 

The diet in such cases will have to be limited to 
foods which do not tend to increase the accumula- Special 
tidn in the intestines. Only malted milk, broths, and Jjjiet 
albumen water should be given, unless the doctor 
allows more variety. Whenever the doctor thinks 
best he will order purgatives or an enema, to secure 
a free passage of the bowels. If an enema is ordered, 
oil should be given the night before. 

In cases where the operation has been for repair 
of laceration of the perineum, which is sometimes In lacera- 
ruptured during child-birth, the stitches should be of the 
douched with warm water after each time of voiding penneum 
urine, as absolute cleanliness is essential if a good 
result is expected. 

Liquid diet is required till the bowels have moved, 
which will probably be the third day. Light diet 
should follow for another day, and then if the bowels 
have been thoroughly cleared and the temperature is 
normal, full diet may be given. 



104 HOME NURSING 

In cases of curettage or scraping of the lining of 
in curet- the uterus, the patient is usually kept on liquid diet 
for forty-eight hours, or until the temperature be- 
comes normal. Douches may be ordered, and a 
sterilized douche point and boiled water will be 
necessary unless some antiseptic is to be used. 

Sometimes in operative cases there is complete in- 
To over- ability to void urine in the recumbent position. This 
ability To difficulty is due to a nervous condition, which may 
void urine not manifest itself in any other way, but unless some 
device can overcome the trouble, the water must be 
drawn. This should on no account be attempted by 
unskilled hands, as unless extreme care is observed 
there is great danger of setting up a distressing in- 
flammation of the lining membrane of the bladder. 
Sometimes, if very hot water is placed in the bed- 
pan, the steam from it relaxes the muscles and the 
patient can urinate. A hot compress over the genitals 
or the sound of dripping water may also effect the 
same result. All these methods should be faithfully 
tried before resorting to catheterization. 

If there has been a rectal operation it is usually 
easier for the patient to urinate lying on the abdomen 
rather than in the usual position. 

In cases of operation for cataract the room should 

Care after be kept- darkened and the patient should not be al- 

?ion° P f e o r r" lowed to turn the head on either side or to lift 

cataract himself forward in the bed, for fear of jarring the 

eyeball. At night the hands must be tied loosely to 

the bed, giving plenty of freedom but preventing them 

from reaching the head while asleep. The first night 

the patient should have some one sit with him, as the 

nervousness is apt to be very great. Liquid or very 

soft diet must be given for a few days, because the 

effort of mastication might do injury to the wound. 



CARE OF OPERATIVE CASES 105 

Another operation which is becoming more com- 
mon each year is the removal of the tonsils. These On re- 
are small bodies situated in the back of the throat, of°the 
and their function in health is a very important one. tonsils 
They stand as sentinels to arrest the progress of any 
foreign particles which may find their way into the 
lungs. These particles, whether dust or micro- 
organisms, are absorbed and disposed of by these 
glandular bodies. In that case the system is entirely 
unaffected by such germs-, which might otherwise 
cause disease. When the tonsils become diseased their 
absorptive function may be increased, but their power 
of disposing of the absorbed matter is impaired, and 
there is besides this the mechanical obstruction to the 
throat and nasal passages, due to their enlargement. 
Hence we find a patient with enlarged tonsils very 
susceptible to colds and often suffering with other 
disorders of digestion or catarrhal affections, and 
generally with marked nervous symptoms. 

With these facts in mind, there need be no hesi- 
tation in following a doctor's advice as to their re- The care 

T-i • 1 which 

moval. I he operation is an unpleasant but not a follows 
painful one, and the after-care required is slight, be- 
yond frequent rinsing of the mouth and throat with a 
weak solution of peroxide of hydrogen or whatever 
wash is ordered. There will probably be vomiting of 
blood and mucus, which has been swallowed during 
the operation, and, though very disagreeable, it need 
never seem alarming. 

CONVALESCENCE 

The period of convalescence, as people in general 
realize, is apt in some respects to be the most trying. Difficulties 
Whatever excitement the acute stage of the sickness ^scen™* 
has furnished has tended to make one forget the 



106 HOME NURSING 

weariness, and now while fatigue is uppermost even 
more responsibility is given over to the nurse as the 
doctor lessens the number of his visits. Convales- 
cence may be rapid or very gradual, but in either case 
great watchfulness is needed because the patient's 
own feelings are no trustworthy guide to the amount 
his strength is equal to, and no patient is able to 
realize this, particularly if it is the first illness. 

In surgical cases, unless there has been a heavy 

When drain upon the system and great depletion of strength 

recovery previous to the operation, a speedy recovery may be 

lookecTfor l°°ked f° r - Less caution is usually necessary in the 

matter of diet than must be observed in medical cases, 

but rich and heavy food should never be brought to 

the sick-room. The patient's whims and fancies can 

often be indulged, but it should not surprise, much 

less offend, the nurse if after taking great pains to 

prepare some special delicacy, it is not touched or is 

even set aside with querulous impatience. 

Some persons seem to have less control over 
irascibii- their feelings than others, and it is true that irritability 
the °corwa- of disposition sometimes accompanies weakness of 
lescent body in persons naturally sweet-tempered. If patience 
is exerted for a few days till a little more strength is 
gained, the patient will generally realize that he is 
unreasonable and be able to gain better self-control. 
Any one of us as a patient is liable to feel this 
irascibility, and it is well to recognize that while much 
is excused when bodily weakness has impaired the 
will, the effort to strengthen it must not be over- 
looked or indulgence in ill-temper allowed. 

In preparing a tray for an invalid it should never 

Ways of be forgotten that small portions daintily served will 

his food quicken the appetite when a carelessly prepared meal 

may be left untouched, though the patient very likely 



CARE OF OPERATIVE CASES 107 

will not realize why he can not eat. It is far better 
that too little rather than too much be furnished. A 
half cup of soup served alone and very hot, a deli- 
cately browned chop with a few green peas placed on 
a hot plate with a hot cover, a piece of roasted potato 
rolled in a napkin beside the plate, a bit of bread and 
a small serving of some light dessert, furnishes an 
ample dinner for full diet. A simple salad may be 
added if the patient enjoys it. A single flower or a 




A Nightingale. The Corners Turned Back are to be Fastened as Sleeves 

sweet-scented leaf laid on the tray is always appre- 
ciated, but one must not make the attempt at orna- 
mentation elaborate. 

It is most annoying to a patient to be constantly 
beset with questions as to what he would like to eat. Avoid 

tt 1 i iii- i -,i discussing 

He does not know, and the thing that will give most his food 
pleasure is that which has not been discussed before 
him. The nurse should be on the alert to observe 
and to remember his tastes, and when the right occa- 
sion comes can often give a pleasant surprise by placing 
quietly before him some favorite or new dish which 
has not been spoiled for him by being talked about. 

When a patient begins to sit up in bed a loose 
flannel jacket or a nightingale should be slipped on. 



108 



HOME NURSING 



The first 
loose wrap 



The first 
sitting up 



Extreme 
weakness 
after 

illness 



Dress for 
man and 
woman 



This latter is a wrap that is easily made and very 
convenient. Two yards of flannel of ordinary width 
are required. Cut a straight slit six inches deep in 
the middle of one side, turn back the points so 
formed for a collar and those of the corners furthest 
from it for cuffs ; bind or pink the edges, and add 
buttons and buttonholes for front and cuffs. 

Half an hour is a sufficiently long time for a pa- 
tient to sit up for the first day. As improvement in the 
patient's condition is made the time for sitting up can 
be increased and he can be lifted to an easy chair or 
sofa for a change. At first he should not be kept up 
longer than the time necessary to make the bed, when 
he will probably be very willing to return. 

The extreme weakness that is felt after having been 
kept in bed for some weeks, even though the illness 
may not have been severe, is always surprising to one 
who realizes it for the first time. On no account should 
the patient be allowed to get up and dress himself, and 
some one must always be near to help him with his 
first steps or he will be very likely to fall. Not more 
than one person should be in the room, unless other 
assistance is necessary, as it is best to make the con- 
fusion as little as possible. 

The room should be warmer than when the patient 
is in bed. To provide against a draught, first place a 
blanket in the chair, and when he is seated, fold it up 
over the feet. A footstool is always desirable. The 
clothing should be sufficiently warm, but not cumber- 
some. A man will be more comfortable in a warm 
bathrobe when the time comes for walking about the 
room and a woman should not be burdened with a tea- 
gown having a heavy train, but should wear a loose 
short wrapper. 

A patient should not feel obliged to see all the vis- 



CARE OF OPERATIVE CASES 109 

itors who call. Even if he wishes it this is unwise and 

the nurse should protect him against the fatigue which Protect 

- n , r. , thein- 

is sure to tollow too much company, borne people valid from 
understand perfectly the limitations of a sick person's %lsltor 
strength and a short and cheery call from such is a 
benefit, but others with equally good intent make no 
distinctions and wish to stay on for a lengthy visit as 
if the patient were well. Two visitors coming together 
always make it harder for the invalid, as there is more 
strain in talking, and it is better that they come at 
different times if possible. 

Place the visitor's chair in a good position near 
the bed where there will be little effort for the patient Suggest 
in listening to what is said and be on the watch for ca rier go 
the first sign of fatigue, then do not hesitate to sug- s[^ 5 rst of 
gest that the visit must be ended and the patient left f *tigue 
to rest. If this is done with good nature and in a 
spirit of friendliness, taking for granted that the good 
of the patient is the first consideration, the visitor need 
not feel anv embarrassment. 



VII 



ACCIDENTS AND EMERGENCIES 



Shock— Hemorrhage— Bleeding from Nose — Bleeding from .Lungs— Fainting 
— Fractures — Dislocations — Contusions — Sprains — Chilblains — Frostbites — 
Toothache— Warts— Cuts— Burns and Scalds— Foreign Bodies— Sunstroke 
and Heat Exhaustion — Artificial Respiration -^ Insect Bites — Bites of 
Snakes and Rabid Animals— Poisons 



Simple 
directions 
every one 
ought to 
be ac- 
quainted 
with 



Keep 
away the 
curious 
crowd 



In the city 



EVERY household may expect a certain amount of 
anxiety and trouble over slight bodily accidents, 
especially if there are children in the family, and at any 
time one ought to be prepared to meet these with in- 
telligence and also so far as it is possible to face the 
graver emergencies which may come in the same way. 
It has often been noticed that persons thought to be 
nervous and unstable in time of alarm show a self- 
control and power of directing others that is very sur- 
prising. It is most unfortunate when at such times 
the mind is able to think clearly, yet is ignorant of 
how to act. Some simple directions every one ought 
to be acquainted with follow. 

The flock of well-intentioned but helpless individ- 
uals who gather about when an accident has occurred, 
must be kept as far as possible from the patient, so that 
he may have plenty of breathing space. The assistance 
of a policeman will probably be necessary in order to 
keep the crowd away. If the accident has taken place 
in a house curious neighbors who come ready with sug- 
gestions must be kept out and not allowed to throng 
into the room. 

In the city an ambulance can be summoned in a 
few moments, and if a policeman is at hand he will 
attend to that, if not some reliable person may be sent 
(no) 



ACCIDENTS AND EMERGENXIES 111 

to the nearest police station or to telephone for the 
conveyance. 

If the accident occurs on a country road, the first 
thing to do, if there is no hemorrhage to be arrested, is On a coun- 

t 11 11 try road 

to get the patient ready to be moved to the nearest 
house. If the patient is insensible, he should be turned 
on one side and the head raised on a level with the rest 
of the body so that he can breathe more easily. His 
clothing should also be loosened, especially about the 
neck and abdomen. If the patient can swallow, water 
may be given to drink and the face can be bathed or 
sprinkled with water, but no stimulants should be 
given unless it is clear that they are needed. 

SHOCK 

If there is shock or collapse as a result of the ac- 
cident, it will be shown by a cold and clammy condi- The con- 
tiom of the skin and extreme pallor or blueness about s iock or 
the lips and finger-nails. The pulse grows very feeble, collapse 
if indeed it can be felt at all ; the patient will complain 
of faintness and the breathing will be irregular and 
sighing. Such a condition demands prompt action if 
life is to be saved, and here stimulants are called for 
without delay. 

Brandy is more useful than wine and should be 
given in small quantity, watching its effect. If the Alcoholic 
pulse grows stronger, the breathing deeper, and the ^oiiaple, 
body warmer, it may be kept up in teaspoon doses 
every fifteen minutes till there is complete reaction, 
when it should be discontinued. If there has been no 
loss of blood, alcoholic stimulants should be used spar- 
ingly and entirely withheld if no sign of improvement 
follows the first dose. Strong coffee may be used and 
is always safe, though not so practicable, because of the 
delay necessary in obtaining it. 



112 HOME NURSING 

If there is bleeding or local injury of any sort, it 
How to must be treated according to the directions to be given 
the doctor ^ ater on * ^ written message stating as clearly as pos- 
sible the nature of the case should be sent to the near- 
est doctor, as it is never safe to trust to a verbal mes- 
sage, no matter how reliable the person may be who is 
to deliver it. 

If it seems advisable before the doctor arrives, the 
patient may be removed to the nearest house. If there 
has been an injury to the head of any serious account 
do not allow him to walk, even if he seems quite able. 
He must be made to lie down and transported as easily 
How to as possible. A stretcher can be made of a blind, a door, 
patient or an y stout board upon which the patient can lie 
horizontally, and those who carry it should be in- 
structed not to take it on the shoulder, but with the 
hands, as there will be less jolting if carried that way. 
It. is better also if they do not attempt to keep step. 

HEMORRHAGE 

Bleeding from an artery may be recognized by the 
Bleeding wav the blood spurts out in bright red jets. If a vein 
from an } s injured the blood oozes forth and is duller in color. 

artery * 

Bleeding from an artery is always serious, because of 
the quantity of blood that escapes in a short time* 
owing to the amount of pressure in the blood-vessels, 
and it must be arrested at once. 

The blood coming through the arteries is being 
Directions carried away from the heart, while that in the veins is 
fng the*" returning to it. . For this reason it is plain that bleed- 
hemor- [ n g f r0 m an artery must be checked by means of pres- 
sure above the wound, i. e., between it and the heart, 
whereas that from a vein demands pressure below the 
wound. 

If a limb is bleeding it should be elevated above the 



ACCIDENTS AND EMERGENCIES 113 

level of the heart, and if pressure with the finger is 
not sufficient to check the flow of blood a handkerchief 
may be knotted or a smooth stone tied in it and the 
knot or stone placed directly over the wound or upon 
the artery above the wound if the bleeding is arterial. 
Another handkerchief is used to tie around the limb if from 
in order to hold the compress in place, and through the a hmb 
knot of this, which should be rather loosely made, a 
stick should be carried and twisted until sufficient pres- 
sure is applied to stop the hemorrhage. If one end 
of the stick is tucked under the edge of the handker- a tour- 
chief, it will be kept from untwisting. Such an ap- bandage 
paratus is known as a tourniquet bandage, and should 
not be left on a limb longer than an hour for fear of 
gangrene resulting from the stoppage of circulation. 

The limb must be examined from time to time, and ^ r< j in ^ b 
if it becomes very cold and dark colored the bandage 
must be loosened. 

The main artery of the arm runs along the inner 
side of the large muscle in front, keeping further for- Main 
ward as it nears the elbow. It is most easily found the arm 
and compressed a little above the middle. 

The artery on the thigh runs a similar course. A 
little above the knee it passes to the back of the bone. Main 
For injuries at or above the knee, the compress should *he\l g ° 
be applied high up on the inner side of the thigh with 
the knot and stick on the outer side. When the lower 
leg is wounded, the compress should be placed at the 
back of the leg just above the' knee. 

If a vein is bleeding, a compress applied directly When a 
over the wound will be all that is usually required, deeding 
The tourniquet is not to be used. 

If a bandage can not be readily applied to the part 
that is bleeding, ice wrapped in a cloth and placed Use of ice 
over the wound often answers the same purpose. 



Remedial 
measures 



114 HOME NURSING 

If there is bleeding from the palm of the hand the 
hand should be closed tightly over a wad of cotton and 
the arm raised and held above the head. 

BLEEDING FROM THE NOSE 

Bleeding from the nose, unless it results from ac- 
cident to the head, is generally of slight moment, and 
is occasioned by the effort on the part of Nature to 
relieve a congested state of the head. The common 
practice of holding the head over a basin is the surest 
possible means of increasing the bleeding. 

The nead should be kept erect or thrown back, and 
a cold compress held to the nostrils. After a few 
|JJ_ bl e f ed " moments the blood will in all probability stop flowing, 
the nose an( i the head will feel relieved of pressure. If the 
bleeding does not stop soon, pressure should be made 
with the finger on the centre of the upper lip, as this 
will compress the facial artery. Bits of ice or cloths 
wrung out in cold water should be laid on the back 
of the neck, and the arm raised above the head. The 
lifting of the arm distributes the force of the heart's 
action and relieves the pressure in the large blood- 
vessels supplying the head. If bleeding still continues, 
the nose may be syringed with ice-cold salt solution, 
vinegar or water. After bleeding has ceased, blowing 
the nose should be avoided for some time, as it may 
dislodge some of the clots which have formed there and 
bring on further bleeding. 
When the ^ after resorting to these measures, bleeding is 
should be st *^ uncontrollable, it should be regarded as a hemor- 
summoned rhage, endangering life, and the doctor summoned. 

HEMORRHAGE FROM THE LUNGS 

Blood which comes from the lungs is usually 
coughed up and is so mixed with air that it has a 



ACCIDENTS AND EMERGENCIES 115 

somewhat frothy appearance. Blood coming from the 
nose or throat is sometimes supposed to come from 
the lungs. 

If hemorrhage is really taking place it is a serious 
symptom, and the patient's condition will soon indi- Serious- 

. . , ness of 

cate the need of wise measures to preserve his strength hemor- 
and cheek the hemorrhage. The pulse will grow rapid rhage 
and weak and there may be signs of collapse such as 
cold hands and feet, blueness about the nostrils and 
nails, dizziness and ringing in the ears. The patient 
should be kept absolutely quiet, not even being al- 
lowed to move his position himself or lift his hand. 
Bits of cracked ice should be given frequently and Treatment 
small quantities of cold liquid nourishment. Ice-cold 
cloths or an ice bag should be placed over the chest, 
and the head and shoulders slightly elevated. Hot- 
water bags may be placed at the feet. 

If the arrival of a doctor is delayed, straps or 
bandages can be applied tightly around the ankles and To c heck 

. the flow 

wrists to check the now of blood passing to the lungs of blood 
and thus give opportunity for clots to form in the 
bleeding vessels. This may serve to entirely check the 
hemorrhage. The bandages should be put on one arm 
and the opposite leg, left in position not more than five 
minutes, and the same thing be repeated to the other 
limbs, one set of bandages being left on till the others 
are in place. 

FAINTING 

Fainting, which is sometimes confounded with 
shock, is occasioned by there being an insufficient Treatment 
amount of blood sent to the head. The patient should jjgrson 
be laid on his back with the head slierhtlv lower than ^ vl ?° h f s 

° J fainted 

the rest of the body, the clothes loosened and plenty 
of fresh air admitted. Cold water may be sprinkled 



116 HOME NURSING 

over the face, or the forehead bathed with it. This 
treatment will usually be enough to restore conscious- 
ness. Ammonium salts should never be held close to 
Avoid am- the nostrils of an unconscious person, as bronchitis has 
salts been known to follow the extreme irritation of the re- 

spiratory tract caused from its use. 

FRACTURES 

Fractures or broken bones are among the more or 
less frequent accidents to be considered. It is a corn- 
Have the mon belief that there should be no delay in having a 
bon e en fracture set, but it is far better that a competent doctor 
accurately or sur g eon should be found to do it, even if it take a 
day or two, than that splints should be applied in a 
clumsy and ineffective manner, which can only cause 
deformity in the end. 

The essential thing to be done is to place the in- 
Care be- jured part in as comfortable a position as possible, tak- 
setting 6 ing care not to handle it more than is absolutely nec- 
essary, as there is danger of the surrounding tissues 
being bruised and blood-vessels cut by the jagged ends 
of the broken bone. Clothing can be ripped along the 
seams or cut if necessary and slowly removed, begin- 
ning with the uninjured side. 

An injured limb should never remain unsupported 
Support- for an instant. If the hands are slipped underneath, 
infured the one below and the other above the fracture, the 
limb limb can be gently placed in a natural position and 

should be slightly elevated. Gentle extension is nec- 
essary in order that the split bones may not rub to- 
gether. 

Temporary splints can be made of pasteboard, 

Temporary shingles, or some stiff substance which may be padded 

with something soft. A broken leg can be laid on a 

pillow, which is then bound closely around it. If the 



ACCIDENTS AND EMERGENCIES 117 

thigh is broken, the splint must extend from the arm- 
pit to the ankle and should be bound to the leg at fre- 
quent intervals by means of towels or large pieces of 
cloth. 

If the upper arm is broken it can be bound to the 
side of the body. If it is the forearm, padded splints in a 
should be placed above and below it and a bandage ap- arm 
plied after making slight extension by drawing gently 
on the patient's wrist. The arm when bandaged should 
be hung in a sling which ought to be wide enough to 
support it from the elbow to the finger-tips. 

For a fractured collar-bone, the patient must be 
laid flat on his back without a pillow. A pad is placed ^reJcoi- 
in the axilla and the arm of the injured side is carried lar bone 
across the chest and bound in place. This position will 
separate the ends of the bones so that they can not rub 
together. 

If the ribs are broken, a broad body bandage is 
applied tightly around the chest to limit its motion. A broken 
If the patient raises any blood it is a serious symptom, " 
probably indicating that one of the sharp edges of 
bone has pierced the lung tissue. 

If a skull fracture is suspected, the patient should 
be placed in a dark room and kept perfectly quiet on in frac- 
his back with the head slightly raised and cold cloths the skuii 
or an ice bag applied to it. No stimulants should be 
given. Any oozing of blood or serum from the ears 
is significant and should be made known to the doctor. 

DISLOCATIONS' 

In dislocation the muscular contraction is so great 
that its reduction becomes more difficult the longer it 
is delayed. A dislocated joint is always very painful, a disio- 
but there is little that can be done for the relief of a cated joint 
patient before the arrival of the doctor. Cold appli- 



118 



HOME NURSING 



A dislo- 
cated jaw 



cations can be made to the injured part, in order to 
retard the swelling. 

A dislocated jaw may be reduced by simple meas- 
ures, which should be resorted to if no doctor is near. 
The thumbs should be placed upon the back teeth, the 
fingers of each hand under the jaw and considerable 
pressure be brought downward and backward till the 
jaw slips into place. When this happens, the teeth are 
brought suddenly together, so that the thumbs will 
need to be well protected. 



How to 

treat 

sprains 



CONTUSIONS 

Contusions or bruises are best treated with hot ap- 

Treatment plications of arnica or hamamelis diluted half with 

water. If the skin is abrased, the hamamelis should 

be used in preference to the arnica. A warm bath 

often gives relief after a general contusion. 

SPRAINS 
Copious douching with hot water, followed by 
cold, is excellent treatment for a sprained joint. This 
should be kept up alternately for fifteen minutes two 
or three times a day if good results are to follow. The 
sprained joint must be kept perfectly at rest, and a 
cold compress kept on in the intervals between the 
douchings. 

CHILBLAINS 

If there is a tendency to chilblains, the feet should 
Remedies be loosely and warmly clad, and after they have been 
exposed to cold they should be gradually warmed 
rather than brought at once to the heat. Sometimes 
painting with iodine relieves the extreme itching. If 
chilblains are persistent, the condition should be made 
known to a physician, as ulcers may develop if the 
soreness is neglected. 



blains 



ACCIDENTS AND EMERGENCIES 119 



FROSTBITES 
When a part of the body has become frostbitten, it 
is essential that the circulation be restored very grad- Treat with 

. ice water 

ually, by friction with cloths wrung out in ice water or 
snow. Sudden heating of a frozen part causes de- 
struction of tissue and gangrene. 

TOOTHACHE 

Toothache is often relieved if there is a cavity 
which can be plainly seen by carrying in a wisp of ab- Treatment 
sorbent cotton wet in pure carbolic. This must be ache from 
done carefully, in order that the gums immediately a 
surrounding the tooth shall not be burned with the 
acid. A toothpick smoothed so that the cotton will 
not catch on it and be drawn out is a good thing to 
use. 

It is well to practice first using plain water to 
moisten the cotton until it can be done skilfully enough 
to attempt with the acid. The merest fleck of cotton 
is sufficient to use and is wound lightly on the end of 
the toothpick and moistened very slightly with the 
acid. 

A good light is necessary in order to see well 
enough to carry the cotton easily into the cavity. The 
same treatment may be used, substituting compound 
tincture of benzoin for the acid, but its effect is not 
likely to be so lasting as the latter. 

WARTS 
Warts can be successfully removed by the use of 
glacial acetic acid introduced twice a day into the roots To remove 
of the growth. This can be done best by means of a 
toothpick without cotton. The acid should be confined 
to the centre of the wart, which will begin in a few 
days to crumble away. It may take several weeks for 



120 



HOME NURSING 



Need 
of care 
of cuts 



a wart to disappear entirely under this treatment, but it 
is sure to yield in time. The use of nitric acid, though 
causing the wart to disappear rapidly, is exceedingly 
painful, whereas the milder acid has no unpleasant 
effect. 

CUTS 

Small cuts must be properly cared for, because of 
the danger of their becoming points of infection. It is 
better that a fresh cut should bleed somewhat freely, 
in order that any foreign substance which may have 
found entrance shall be washed out of the wound. If 
the wounded part is placed in warm water and gently 
squeezed, it will assist the escape of impurities. After 
the bleeding is checked, a perfectly clean piece of 
muslin or linen wet in weak carbolic or other antiseptic 
solution should be laid over the wound and a bandage 
applied. 

Nothing in the nature of salves or ointments is 
No salves needed over a clean wound, and it is better that they 
should be dispensed with, because they sometimes carry 
infection unless taken from an absolutely fresh sup- 
ply. If anything seems to be needed, however, to keep 
the cloth from sticking to the wound a very little of 
the carbolized vaseline may be spread on the cloth. 

On no account should cobwebs be used to arrest 
Never use bleeding from a wound. This old-fashioned device has 
no doubt accomplished its purpose many times and 
established the clotting of the blood just as lint is able 
to do, but in using the former we bring to the wound 
the dirt and dust which we know to be so disastrous. 
It is because Nature stands ready to correct our mis- 
takes that serious consequences do not more often re- 
sult from our carelessness. The utmost care should 
be taken to keep even slight wounds perfectly clean, 
in order to avoid the possibility of serious infection. 



or oint 
merits 



cobwebs 



ACCIDENTS AND EMERGENCIES 121 

Before dressing a cut, the hands of the one doing 
the dressing should be thoroughly scrubbed and noth- in dressing 
ing but the dressings touched until the wound is ban- 
daged. The edges of the wound should be brought 
neatly into apposition before the wet pad is applied. 
If the cut is a long one and there is surgeons' plaster 
at hand, narrow strips of it can be used to hold the 
edges together. The ends of the cut should always 
be left uncovered and free for the sake of drainage. 

If for any reason the dressing of a wound has to 
be cared for at home with an occasional visit from the 
doctor, he will doubtless give full instructions in regard 
to it. If, however, he should be careless about direc- 
tions or they should not be perfectly understood, the General 
following general method will always be safe and use- dressing 
ful to adopt. After placing a clean towel on the table, a wound 
lay upon it the dressings to be used, and, if needed, the 
little basin in which forceps and scissors have already 
been boiled. If a solution is to be used, that, too, . 
should be in a bowl on the table, or if an ointment is 
to be applied, it should be spread ready for use. A 
silver table knife may be boiled to use for spreading 
the ointment. After removing the soiled dressings and 
placing them in a basin or paper which has been pro- 
vided for the purpose, the hands should be scrubbed 
vigorously with a nail brush for several minutes and 
rinsed in a basin of some antiseptic solution. A piece 
of sterilized gauze may be used for drying them. 
From this time on, nothing may be handled but the 
dressings and instruments until the wound is covered. 

BURNS AND SCALDS 

A scald is an injury caused by moist heat, while a 

burn is occasioned by dry heat. Burns are usually clas- degree" 66 

sified as of three degrees, the first showing mere redness of burns 
6 Vol. 3 



122 HOME NURSING 

of the skin, the second extending through the true skin, 
and the third involving the deeper tissues. This classi- 
fication, however, does not indicate anything in regard 
to the serious nature of a burn, because the extent as 
well as the depth of the injury has to be reckoned 
with. A superficial burn which covers a large sur- 
face, thus interfering for the time being with the true 
function of the skin, may be more alarming in its con- 
sequences than a small but deep burn. A burn of the 
first degree, which involves a third of the surface of 
the body, is usually fatal, especially in the case of a 
child. This is largely because of the additional amount 
of work which is thrown upon the kidneys. 

A superficial burn may be treated with a solution 
To treat of bicarbonate of soda, which is found in every house- 
LiaiTurn hold ^ or cooking purposes, or dusted with flour, which 
is cooling, if the skin is not broken. Much pain may 
be spared if the air is excluded from a burn and dress- 
ings should be applied for this reason if for no other. 

When the skin is broken, wet applications should 
be made. The use of a powder would be irritating by 
caking upon the raw surface. As soon as the blisters 
Punctur- form they should be punctured at their base with a 
Misters large needle which has been held in the gas jet a 
moment in order to burn off inpurities and make it 
sterile. The serum that oozes forth can be gently 
mopped up with absorbent cotton. 

Boracic acid solution, or better still one made of a 

mixture of boracic acid and salicylic acid and known 

Thiersch's as Thiersch's powder, is cleaner to use than the oils 

powder r ' 

and ointments which were much in vogue at one time. 
If a burn is extensive or very deep, a doctor must give 
advice about its treatment, but for an ordinary small 
burn the solution made of Thiersch's powder will be 
found to keep the burn clean and cause it to heal 



ACCIDENTS AND EMERGENCIES 123 

rapidly. The solution is made by adding half a tea- 
spoon of the powder to a pint of warm water and the 
dressing should be kept moist. This is best accom- 
plished by covering the dressing with oiled silk or firm 
rubber tissue and cutting holes here and there, through 
which to pour the solution. 

In dressing a burn, all the ordinary precautions of Absolute 

7. 11 1 r i cleanliness 

absolute cleanliness are to be observed as tor the treat- 
ment of any wound. 

If a burn is severe, complications may be looked 
for. Brain disturbances, bronchitis, and pneumonia are Serious 
not uncommon sequelae, and ' if the alimentary tract J^ s burns 
has been injured the digestive process may be seriously 
impaired. The danger of shock is always great after 
a burn of any large extent, and the patient should be 
kept quiet and warm and stimulants given to keep up 
the heart's action. 

Great deformity sometimes results in the case of 
severe burns from the contraction of the skin in heal- J° P revent 

deforming 

ing. Something can be done toward preventing this contraction 
by a wise adjustment of splints in order to keep the muscles 
parts in the best position. When the splints are re- 
moved for dressings the joints should be moved freely 
to guard against stiffness. 

The diet should be light and liberal in order to keep 
up the patient's strength, which is having a heavy drain iet 
upon it while the healing process is going on. 

There would be fewer grave results of accident by 
fire if more people realized how to act in an emergency, if your 
If one's own clothes catch fire, lie down instantly and C atch fire 
roll on the floor, remembering to keep the mouth closed 
in order not to inhale the flames. If a rug is at hand 
and can be reached that will help to smother the flames. 
The first impulse is very naturally to run and call for 
aid, but nothing that one could do would be more dis- 



124 



HOME NURSING 



If an- 
other's 
clothes 
catch fire 



astrous, since the current of air thus set in motion only 
serves to fan the flames. 

If another person is afire, do not hesitate a moment 
to knock him down and to wrap quickly about him 
whatever is at hand in the way of a rug, blanket, shawl, 
or overcoat, being careful to protect the head first. 



FOREIGN BODIES 



To float 
away for- 
eign body 
on the 
eyeball 



If a par- 
ticle is 
caught in 
the lid 



If a par- 
ticle is 
imbedded 
in the 
eyeball 



Any foreign body in the eye causes great pain and 
discomfort. If the particle is not imbedded in the eye- 
ball it can often be floated out and into the nasal pas- 
sage by lifting the lid of the eye outward and down- 
ward and holding it a moment. This causes the tear 
glands to secrete freely and also throws the lower eye- 
lashes against the eyeball in such a way that they act 
as a brush. If the nose is blown vigorously while the 
eyelid is being held, the offending particle will usually 
disappear. 

If a particle gets caught under the lower lid and 
can be seen there it may be wiped out with the fold of 
a soft handkerchief. If it is under the upper eyelid, 
the latter can be folded back over a small pencil or 
knitting needle, the patient directing his eyes to the 
floor while the particle is wiped out. 

The eyeball must always be treated very gently and 
never rubbed hard with the hand. When it is neces- 
sary to examine an inflamed eye let the index finger 
hang over the eyebrow and gently draw up the lid 
without touching the eye, If a particle is imbedded 
in the eyeball and can be plainly seen, it may some- 
times be removed, provided the patient is not nervous, 
by means of a small piece of rather stiff letter paper, 
creased to form a scoop. This can be used to pick out 
the particle and will answer very well if the latter is 



ACCIDENTS AND EMERGENCIES 125 

not too deeply buried. If this is not successful, the 
services of a physician will be required. 

Sometimes a fragment of lime gets into the eye and 
burns into the eyeball. The eye should be bathed at When 
once in some mild acid, as vinegar or lemon- juice di- in the eye 
luted to about one teaspoon to a cup of water. This 
will neutralize the effect of the alkali. 

If it is necessary to put drops into another person's 
eye a medicine dropper is used for the purpose. If the Using a 
drops are to be warmed before applying them (and dropper 
the physician should state whether he wishes this done) 
the medicine dropper after it has been filled may be 
passed once or twice over the alcohol flame. The end 
of the dropper will need to be held up while doing 
this in order that the fluid may not escape as the glass 
expands. 

If some hard substance gets into the ear, there may 
be gentle syringing with warm water unless it is a pea To take 
or bean which obstructs and which would only swell substance 
with the water and add to the trouble. If the lobe of [ n ° m ear 
the ear is gently pulled out and down, the canal is 
straightened so that the water has freer passage. A 
medicine dropper placed on the end of a fountain 
syringe is the best thing to use for ear-syringing. 

If an insect has gotten into the ear, turn the pa- 
tient on the unaffected side and fill the ear with warm When an 
oil or glycerine, which will catch the insect and float in the ear 
it to the outside. Another method is to saturate a 
piece of cotton with a strong solution of salt or vine- 
gar and placing it firmly in the ear, have the patient 
lie on the affected side. After a short time if the cotton 
is withdrawn the insect will probably be found upon it. 

The ear has a most intricate and delicate mechanism 
and serious injury, even permanent deafness, may re- ^eSme^t 1 
suit from careless treatment. The practice of thrusting of the ear 



remove 

abnormal 

wax 



126 HOME NURSING 

hairpins and other articles into the ears is a very dan- 
gerous one, and nothing should ever be introduced 
further than it is possible to get the little finger. 

Sometimes the natural secretions of the ear fail 

A physi- in their normal function of keeping the wax moist, so 
that the latter collects into a hard ball and so obstructs 
the passage as to cause temporary deafness. This 
condition is easily recognized by a physician and with 
the proper instruments the wax can be removed with- 
out causing any distress to the patient. 

If a child gets something lodged in the nostril make 

To dis- hi m take a deep breath, close the mouth and unob- 

lodge a x 

foreign structed nostril and give a strong expiration. The 

the nostril force of the air which has been excluded from the 

other outlets will usually blow out the object. 

A foreign substance that has been swallowed, such 
as a button, coin, etc., usually passes through the in- 
testines and no harm results from it. It should always 
SSV ^ e watched for in the stools. If a sharp object has 
substance been swallowed it is best not to give purgatives, but 
lowed. to restrict the diet to solid foods, so that the object 
may become imbedded in the food and carried along 
without causing injury. 

SUNSTROKE AND HEAT EXHAUSTION 

The danger of sunstroke is less in the country, 
what in- w here the air is pure and where people live with less 

creases c r r 

danger of nervous tension, than in the overcrowded districts of 
the city, where the reverse is true. People also of 
intemperate habits are more liable to suffer from the 
excessive heat. 

The terms sunstroke and heat exhaustion are not 

Sunstroke synonymous, the effects being quite different in each 

and treat- J J _ , . , *>■} ' . . „ , 

ment case. In cases of sunstroke the patient usually be- 
comes suddenly unconscious and the fever runs ex- 



ACCIDENTS AND EMERGENCIES 127 

tremely high.. The respiration is very labored, and 
the pulse rapid and weak. Prompt measures must 
be taken or the issue will be fatal in many cases. A 
doctor must be summoned at once, and treatment 
with ice baths will doubtless have to be kept up. 

In cases of heat exhaustion the onset is more 
gradual. The patient feels weak and dizzy. He is Heat ex - 

. haustion 

not necessarily unconscious, but shows signs of col- and its 
lapse. The temperature will be found subnormal, treatment 
i. e., below 98 Fahrenheit. The pulse is weak and 
rapid and the breathing much quickened. The treat- 
ment is the same as for shock, and the patient is kept 
in a darkened room or in a cool, shady place out of 
doors with the head low. Aromatic spirits of am- 
monia, one teaspoonful in a little hot water every 
half-hour for three or four doses, may be given until 
the doctor comes. Strong coffee may also be used. 
In convalescence from heat exhaustion great care, 
must be taken that there is no exposure to extreme 
heat. The direct rays of the sun are not necessary to 
produce heat exhaustion. It may follow exposure to 
intense heat of any kind, and persons who have once 
suffered are liable to another attack. 

ARTIFICIAL RESPIRATION 

In accidents from drowning, strangulation, or suf- 
focation, where the supply of air for any reason has when 
been cut off from the lungs, artificial respiration must respSon 
be resorted to, as it is often possible to force the is used 
lungs to act, and the effort should be kept up till it 
is evident that it is hopeless, and that conclusion should 
not be reached short of two hours of faithful work. 

There are several methods of establishing artifi- 
cial respiration, there being little difference in their 
value so long as the lungs are made to expand. In 



128 HOME NURSING 

a first any case the tongue must first be fastened to keep 
tabHsStS" it f rom falling back upon the windpipe. This can 
respiration eas ity be done by holding it down to the chin by 
means of a rubber band. If the case is one of drown- 
ing or of strangulation the patient must be turned 
over on his face and the throat cleared of any col- 
lection of mucus that may be obstructing it. 

In the method known as Sylvester's the patient 
Sylvester's i s ^jd on hj s back with the head and shoulders slightly 
raised and the clothing loosened. Standing at the 
patient's head and grasping his arms just above the 
elbows, bring them slowly out from the body and up- 
ward till they meet over the head. They are held 
there for two seconds and brought slowly back till the 
elbows come together on the chest with slight pres- 
sure. . These movements should be repeated steadily 
and not more rapidly than sixteen times a minute. 

INSECT BITES 



Mosquito or spider bites can be relieved by lotions 

Small bites of ammonia or salt. The sting of a wasp or bee, if 

left in the flesh, may set up considerable irritation. 

It can be removed by making firm pressure around it, 

BITES OF SNAKES AND RABID ANIMALS 

Prompt action and heroic treatment are demanded 

Speedy when dealing with the bite of a venomous snake or of 

otTZTo- a mad animal. The bleeding of the wound should 

rabid Mte ^ e encouraged. If it is on an arm or leg this should 

be firmly bandaged at once above the point of injury, 

in order to cut off circulation for the time being. 

The wound must then be sucked or cupping glasses 

applied before the poison is taken into the system. 

Finally it must be deeply burned with a hot iron and 

poulticed. If more than half an hour has elapsed 



ACCIDENTS AND EMERGENCIES 129 

since the bite the method of burning out the wound 
is useless. 

Pasteur's treatment by inoculation of virus made 
from emulsions of dried spinal-cord, not only secures Pasteur's 
immunity but has also proved itself a curative measure. 
Both in the Pasteur Institute in Paris and in New 
York this treatment is being carried out daily with 
marvelous success. 

POISONS 

Poisons are known either as irritants, substances 
which corrode the tissue, or narcotics, those which 
cause insensibility by directly affecting the brain. 

Xo time should be lost in giving emetics when a Treatment 
poison has found entrance into the body. A table- Jlnt^S- 1 
spoon of salt or of ground mustard stirred into a cup sons n a ^ e d 
of tepid water rarely fails to produce vomiting, and 
this dose should be given repeatedly till free vomiting 
is secured. After this it is always well to give a pur- 
gative enema to remove any trace of the poison that 
may have traveled as far as the bowel. 

Large draughts of water, milk, white of egg, or 
flour and water should be given to soothe the injured 
membrane of the alimentary tract if the poison is of 
an irritating character. 

For all alkaline poisons acids should be given to 
neutralize their effect, and vice versa for acid pois- 
oning. 

The treatment necessary for narcotic poisoning in nar- 
is strong stimulants (black coffee freely administered), poisoning 
cold effusions and mustard foot-bath. Above all, the 
patient must be kept awake, and will probably have Have 
to be walked about the room vigorously. Poisoning advice 



case of 

milk, or cheap ice cream. Emetics and purgatives 



may follow the use of tainted meat, mushrooms, fish, pc 



130 HOME NURSING 

must be used freely, and a physician should be sum- 
moned at once in all cases of poisoning. 

An antidote is a remedy used to offset the effect 
Definition of a poison in one of three ways. First, mechanically 
dotes by emptying the stomach and bowels to prevent ab- 
sorption; second, chemically, by combining with the 
poison to form a harmless compound ; and third, 
physiologically by counteracting the effects of the 
poison on the system. 



VIII 

INFECTION AND CONTAGION 

Micro-Organisms and Disease— Transmission of Disease— The Protozoa- 
Disinfectants — Methods of Disinfection — Typhoid Fever- 
Erysipelas— Malarial Fever— Dysentery 

MICRO-ORGANISMS AND DISEASE 

IN any discussion on the subject of transmissible 
disease we have to consider the methods by which 
it is communicated before we can understand the Science has 
proper precautions necessary in its care. Science om^view 
has advanced and is advancing so rapidly in its in- of dlsease 
vestigations that each year adds to our knowledge 
and equips us with more effective weapons both in 
the prevention of disease and in its cure. We are only 
in the A B C's in our knowledge of the cause of 
disease, but in so many instances the use of what 
science has offered us will prevent it, and save life, 
that we should try to understand some of the scien- 
tific phraseology and follow the discoveries of the 
investigators as far as may be. 

The terms microbes, micro-organisms, germs, and 
bacteria are all used to indicate the microscopical ^Hv°ng 0p " 
living bodies which are now held responsible for bodies 
many diseases. 

The bacteria are not animal organisms, but are 
the lowest form of plant life, and though invisible 
without high magnifying power, are near relatives of 
the sea-weeds. They are very complex and wonder- 
ful in their variety of shape and in the work they do 
in life, which is by no means exclusively the produc- 
er) 



132 HOME NURSING 

tion of disease. This making of disease is confined 
to a comparatively small class, bacterial work in gen- 
eral being of great service to mankind. 

The decomposition and hence the disposal of 
Work of waste animal and vegetable material is largely carried 

bcictcrict 

on by bacteria. They make possible the renewal of 
worn-out soil by what is known as "rotation of crops," 
- and their presence in our bodies often saves us from 
disease by rendering harmless poisonous matter which 
would otherwise act as an irritant. In short, life on 
the earth would be impossible without this form of 
micro-organism. 

Many of the disease-producing forms have been 

Disease recognized, and the method of destroying them or 

bacteria^ rendering their poisons harmless is the subject of 
investigation, and has led to the modern method 
of fighting tuberculosis, to the antitoxin treatment 
of diphtheria, and to other results which we will 
discuss later. 

At the same time that scientists were pursuing 

The pro- their studies of bacterial life in relation to disease, 
the cause of certain disorders was traced to another 
source. This was another micro-organism, the pro- 
tozoon, which is the lowest form of animal life. The 
protozoa have long been the object of microscopical 
study, because most of them are much larger than 
the bacteria and their life processes may be followed 
with comparative ease. Much of the advanced knowl- 
edge of human structure, needs, and functions has 
been gained through their aid, and the recent dis- 
coveries in connection with malaria and yellow fever 
have brought them into prominence in other than 

The terms scientific circles. The terms microbe, germ, or micro- 



microbe, 

bacteria, and while like bacteria the majority are 



organism are applicable to the protozoa as well as to 



INFECTION AND CONTAGION 133 

harmless, unlike them there seems to be no record of 
especial good to their credit. 

THE TRANSMISSION OF DISEASE 

All infectious diseases are supposed to be trans- 
mitted bv the agency of one or the other of such living Agents in 

ii- ', • t • i i ii infectious 

bodies ; though their presence has been proved, the diseases 
specific germ causing the disease has been recog- 
nized and actually cultivated outside the body in com- 
paratively few instances. 

The disorder begins with the introduction of the 
germs into the system, progresses with their develop- 
ment and multiplication, which is almost inconceiv- 
ably rapid, and terminates with their destruction 
when Nature is able to accomplish it, or with the 
death of the patient when they are victorious. 

The germs causing scarlet fever, diphtheria, 
measles, and other diseases ordinarily included under Germs 
contagion are of such a nature that they are com- different 
municated by simple contact, while a person may re- mtensities 
main with immunity in the presence of patients suf- 
fering with malaria, typhoid fever, tuberculosis, and 
pneumonia unless he is actually inoculated with the 
poisons producing the disorder. 

The bacterial source of typhoid fever, tubercu- 
losis, pneumonia, Asiatic cholera, lockjaw, and other 
less familiar diseases has been proved, and the modern 
methods of prevention and cure are based on what is 
known of the condition under which bacterial life 
thrives or is destroyed. 

The demands which physicians make that their 
patients shall have sunlight and fresh air, the methods Enemies 
of disinfection and fumigation employed in infectious \a e 
diseases are rational, because science has found that 
germ life flourishes best in warm, dark media, that 



134 HOME NURSING 

sun and air are its worst enemies, that continued 
heat, of boiling water in some cases, and of condensed 
steam in others, destroys it, as do also certain so- 
called disinfectants. 

THE PROTOZOA 

The consideration of the protozoa as an agent in 
The part infection has come into prominence through investi- 
insects in gations made regarding the part played by insects in 
disease t k e propagation of disease. These investigations, with 
experimentation, have been carried out mainly in re- 
gard to mosquitoes, and the results have established 
beyond question the fact that the prevalence of mala- 
ria in certain districts is referable to the presence of 
these insects rather than on account of climatic con-, 
ditions pure and simple, and that the protozoa dis- 
covered in the stomachs of mosquitoes found in such 
districts are of the same variety as those found in 
the blood of malarial patients. 

The numerous experiments which have led to these 
Mosquitoes conclusions are given in an article in the " Popular 

carrying 

malaria Science Monthly" by Professor A. F. A. King, M. D., 
fever 761 ° W entitled "Mosquitoes and Malaria," and in books upon 
the same subject by the same author. Equally con- 
clusive results have been reached in the experiments 
with mosquitoes infected with yellow fever, though 
the specific organism causing the disease has not been 
found. "Mosquitoes: How They Live — How They 
Carry Disease — How They Are Classified," by L. O. 
Howard, Ph.D., and later reports on the subject can 
be obtained by applying to the Department of Agri- 
culture in Washington. 

The immediate effects of these investigations have 
been systematic effort in some States to exterminate 
the mosquitoes by the persistent use. of kerosene over 



INFECTION AND CONTAGION 135 

certain swampy districts known as their breeding Efforts to 
places, and the more general care to exclude them na te the 
from houses in malarial regions, by careful and m0S( ^ ult0 
thorough screening. 

The theory of the protozoon origin of other dis- 
eases is put forward by scientists, but has not been 
conclusively proved. Other insects which have been 
known to carrv disease are the common house-flv, the infection 

• from 

small house-fly, and other similar varieties. These house flies 
flies tend to swarm over sputa or excrement, if it 
is left exposed, and their feet are so constructed that 
they must of necessity retain on them minute particles 
of any soft substance with which they come in con- 
tact. Food attracts them with equal certainty, and 
we trace here a direct source of infection. 

All this points to the necessity of careful protec- 
tion of our homes from these pests, and any other 
insects which may have come into contact with disease. as a 
Whenever the poison of a disease lies in the dis- safe & uard 
charges from the body or in the blood, insects may 
be powerful agents in its transmission, and the use of 
screens should be insisted upon as a safeguard. 

DISINFECTANTS 

The following agents for disinfection, together 
with the general scheme for their use, are recom- 
mended by the Board of Health of New York City: 

Sunlight, cleanliness, and fresh pure air are pow- 
erful preventives of disease, and play an equally im- Powerful 
portant part in their cure, but in dealing with cases fiv^" 
of infectious disease the aid of agents known as dis- 
infectants must also be called in. 

After such disease, and also during its course, all 
the articles of small value which have been used in 
contact with the patient in any way should be de- 



136 



HOME NURSING 



Disposition 
of articles 
after an 
infectious 
disease 



Carbolic 
solution 



Care of 
carbolic 



Solution 
of corro- 
sive sub- 
limate 



Chlori- 
nated lime 
solution 



stroyed by fire. Dishes, silver and metal objects not 
injured by water may be made thoroughly sterile by 
boiling in a closed vessel for half an hour, and in 
cities large articles, such as bedding, can usually be 
taken care of by the Health Department. 

A five per cent solution of carbolic is a very power- 
ful disinfectant to be used on clothing, towels, bed- 
ding, etc. It is made by dissolving six ounces of 
the acid in a gallon of hot water. The pure acid is a 
very strong corrosive, and even the five per cent solu- 
tion is too strong for use on the hands. 

If a person is burned with carbolic, pouring alco- 
hol over the cauterized surface gives instant relief. It 
is very poisonous when taken by the mouth, should 
have a poison label plainly upon it, and should be kept 
out of the reach of children. 

Solution of corrosive sublimate is easily made with 
tablets, which are dissolved in water. Directions are 
found on the bottles. It is much less expensive than 
carbolic acid, but is not as useful. It injures metals, 
stains clothing, and is not effective in the disinfection 
of discharges, because it merely incloses the particles 
which it touches in an albuminous coating; its action 
on albumen being to cause it to coagulate. In this 
way the germ is preserved, but not destroyed. It is 
useful in cleaning woodwork and furniture. 

Chlorinated lime solution is one of the most effect- 
ive as well as least expensive disinfecting agents. It 
is prepared by thoroughly mixing six ounces of fresh 
chloride of lime with one gallon of water. It should 
be made only about an hour before using. The danger 
of using this on bedding, clothing, etc., is that it tends 
to destroy the fabric. If it is employed it should be 
thoroughly strained through a cloth and diluted one- 
half. 



INFECTION AND CONTAGION 137 

Milk of lime is equally valuable. The solution is 
made by adding a quart of finely slaked dry lime to 
four or five quarts of water. It should be remembered 
that air-slaked lime has lost its disinfecting power. 

Formaldehyde gas is a very powerful disinfectant, 
commonly used now in the general fumigation of Formalin 
rooms after contagion. The strongest liquid prepara- infection 
tion on the market is the forty per cent solution of this 
gas in water. The five per cent solution is effective for 
the disinfection of discharges, and of dishes, instru- 
ments, etc., and a one per cent solution may be used 
on the hands. Formalin is so expensive that it is rare- 
ly thought best to use it extensively in the household, 
but its action is so powerful that it is taking prece- 
dence over other disinfectants when expense need not 
be considered. 

FORMULA 

Formalin, 5 per cent : Strong formalin, 5 parts ; water, 35 parts. Or, 
Formalin, 5 per cent : 4.75 ounces formalin to one quart of water. 
Formalin, 1 per cent : Strong formalin, 1 part ; water, 39 parts. Or, 
Formalin, 1 per cent : .95 ounces to one quart of water. 
Formalin, 1-5000 : Strong formalin, 1 part ; water, 2,000 parts. Or, 
Formalin, 1-5000: 10 drops of strong formalin to one quart of water. 

Another preparation used in fumigation is gas from 
burning sulphur. This is not regarded with as much Sulphur 
confidence in recent years as it was before the wonder- infection 
ful vitality of disease germs was understood. The 
advantages of the method are that the fumes are very 
diffusible, they do not injure furniture, are easy to use 
and are not expensive. The difficulty in the use of sul- 
phur is in confining the gas in a room for a long enough 
time to destroy the germs. 

Three pounds of sulphur for every thousand cubic 
feet of air space is necessary, the room must be tightly in using 
closed, and all cracks where air might enter must be sulphur 
sealed, by pasting strips of paper over them. It is 
more effective if burned in a moist atmosphere, so the 



138 



HOME NURSING 



Not in 
tubercu- 
losis 



usual method is to place the dish holding the sulphur 
on rests in a vessel containing water. It must be re- 
membered that the fumes blacken metal, and that a 
liberal application of vaseline will prevent this action. 
The bacteria of tuberculosis are able to protect 
themselves from destruction by sulphurous gas by a 
change in their structure, therefore some other method 
of disinfection is necessary after this disease. If for- 
maldehyde gas is available it should always be given 
preference in fumigation. 



In di 
fectin'g 



METHODS OF DISINFECTION 

The formalin solution one per cent or the carbolic 
solution diluted with an equal part of water is to be 



the hands use( ^ * n cleansing the hands. The dry chloride of lime 
is also of value. If the liquids are used, the hands 
should be thoroughly washed in the solution and then 
with soap and water. Especial care should always 
be given the nails. About a teaspoon of the dry chlo- 
ride of lime is placed in the palm of the hand, moistened 
with water, and rubbed thoroughly all over both hands 
and about the nails. Any disinfectant is irritating to 
the skin if used for any length of time. 

It is not only the feces, but also the discharges 
from bladder, mouth, and nose, which must be disin- 
fected or burned. Expectoration and discharge from 
disinfected the nose may be received upon cloths or paper and 
must be burned at once. 

When vessels are used, a solution of lime or carbol- 
ic, acid must be kept in them, and after use the con- 
tents must be mixed with the disinfectant and allowed 
to stand for an hour or more. If carbolic is used, the 
amount should be twice that of the discharge, with 
milk of lime four or five times as great. 

It must be remembered that the intestinal dis- 



All dis- 
charges 
must be 



Use of 

lime or 
carbolic 



INFECTION AND CONTAGION 139 

charges in diseases where these contain the active Thorough- 
germ must be broken up, so that the disinfectant will sentiaT 
be thoroughly mixed with them. They are not disin- 
fected if the solution is merely poured over them. 

In typhoid fever, the discharges from the entire in typhoid 
digestive tract and from the bladder are regarded with dysen- 
suspicion, and subjected to the action of the disinfec- ^^ ^| d 
tant. In dysentery and cholera, the stool and vomited diphtheria, 
matter contain the poison, and in diphtheria, scarlet f ev er, and 
fever, and measles the discharges from the nose and measles 
throat carry the infection. 

Germs are not scattered while the medium in which 
they are contained is kept moist. 

The food which is left after the patient has been 
served must never be taken back to mix with the gar- Disinfec- 

° tion of 

bage from the household. It should be put in a sep- food 
arate covered receptacle, and either burned or sub- remnan s 
jected to the action of a disinfectant. Bacteria thrive 
especially on milk, and therefore milk should never 
be left uncovered in the sick-room. 

In any disease, food should be kept outside the sick- 
room, since it is very liable to become contaminated. 

All washable articles must be put to soak in either 
a carbolic or lime solution, and left for ten or twelve Disinfec- 
hours. They can then be washed in the usual way. clothing 
The boiler containing the disinfectant should be kept 
in a room adjoining the sick chamber, and should not 
be removed till after disinfection is complete. 

A pint of carbolic solution or of milk of lime solu- 
tion should be poured into the closet each time after Disinfec- 
using. Nothing should be thrown into it or into sinks *°" e °_ £ 
without disinfection. If it could be assured that it closets, 
would remain moist and would be held intact in the sewer 
sewer there would be no danger, because the germs pipes 
could not be disseminated and the action of other bac- 



140 HOME NURSING 

teria would in time render them harmless. Accidents, 
however, do occur in sewer pipes, and since a leak 
can give rise to an epidemic of disease, every precau- 
tion must be taken to guard against the deposition in 
the pipes of living germs where it is possible. 

During sickness, the cleaning and dusting must be 

Disinfec- done with cloths wrung: out of a i-iooo bichloride solu- 
tion of ° 
furnishings tion. At its termination, if the Health Department has 

of room. . ± 

an effective sterilizing plant, all bedding, carpets, cur- 
tains, etc., can be removed and made entirely germ- 
free, and it is always advisable, when it is not compul- 
sory, to have the fumigation carried on by the Depart- 
ment. In country places, this responsibility must be 
assumed by the family, and if they are conscientious 
about it, they can accomplish it effectively. 

The wisest plan in contagious diseases is to strip 
a room of woolen curtains, carpet, and unnecessary 
ornaments, and to bring into it for the patient's use 
and amusement only such things as can be burned or 
boiled at the termination of the disease. 

Formalin seems to be the most practical disinfec- 
ts use tant, and knowledge of certain facts concerning it will 
as i°di? ahn make our use of it rather more intelligent. In order 
infectant ^0 exert its destructive action on micro-organisms it 
must have, first : free access to them — hence all cloth- 
ing, curtains, etc., which are left in the room for disin- 
fection must be hung up or spread out so that the 
entire surface is exposed. 

Second : it must be concentrated as far as possible, 
that is the room must be sealed to hold the vapor, and 
more formalin, and a longer time is necessary if there 
is any appreciable escape of gas from an apartment. 

Third : the higher the temperature the more effec- 
tive and more penetrative is the action of the formalin, 
therefore the room should be heated either by turning 



INFECTION AND CONTAGION 141 

on heat from furnace or boiler, or by building a fire in 
stove or heater. 

Fourth : a moist atmosphere is conducive to more 
thorough fumigation, i. e. f steam should be allowed to 
escape into the room in order to get the best possible 
results. A space represented by 1,000 cubic feet is 
supposed to require from two to three fluid ounces of 
formalin and five to eight hours' exposure. 

An especial apparatus is used by the Health De- 
partment, bv which the formaldehyde gas is generated Special 

.11 i.iiiii apparatus 

outside the apartment, and introduced through the 
keyhole till the required amount has passed in, when 
the pipe is withdrawn and the keyhole sealed. 

Household fumigation must be accomplished with- 
out the use of special appliances and can be done as fol- 
lows : The room should be carefully sealed, the temper- 
ature raised as high as possible with safety to it and Household 
its contents, and if possible steam should be allowed ™/ fumiga- 
to escape into it. If the heat of the room is maintained f^^ 11 
by the use of a stove, a large tea-kettle or boiler of 
water may be kept boiling. Care must be taken to pro- 
vide sufficient water for the entire length of time. 
An alcohol lamp may be placed in the centre of the 
room, quite away from furniture, on a metal plate, so 
that there can be no possibility of its tipping over. 
The forty per cent formalin, three fluid ounces, should 
be placed in an open vessel and put oyer the alcohol 
lamp. It is estimated than two ounces of alcohol will 
be required to generate the fumes of this amount of 
formaldehyde. After the lamp is lighted, the person 
who has charge of the fumigation must quickly leave 
the room, and seal the door. 

The nature of the bacteria makes a difference in Nature of 
the amount of disinfectant, and the length of time re- factor'^ 
quired, and whenever the physician can oversee the fumi g ation 



142 



HOME NURSING 



Cleaning 

after 

fumigation 



fumigation, it will be done with a greater assurance 
of success. 

After disinfection, a room should be carefully 
cleaned, the glass, woodwork, and furniture wiped with 
a cloth wrung out of bichloride solution, and then thor- 
oughly washed with warm soap-suds. Cleanliness is 
no less an essential because it is no longer our sole re- 
liance. Dirt is the natural habitat of germ life, and 
the more air, soap and water, and sunshine we let 
into our homes, the more effectually we guard them 
from disease. 



The bac- 
teria 
causing 
typhoid 
fever 



How the 
poison is 
conveyed 



TYPHOID FEVER 

Typhoid fever is one of the diseases caused by a 
micro-organism which has been recognized, cultivated 
outside the body, and proved to produce the disease 
when introduced into the system. This organism is 
found to be one of the bacteria, and its action is con- 
fined to the intestine and chiefly to a restricted area, 
where it causes inflammation and ulceration. It must 
be taken in through the alimentary canal, to cause the 
disease, but can not be contracted by contact, hence it 
is not classed with the contagious diseases. 

It may occur at any time of _year, but comes most 
usually in the autumn. Infection is always due to a 
previous case of the fever, and the germ is conveyed 
chiefly through the stools, though all discharges from 
the nose or mouth, vomited matter and the urine may 
carry the poison and must be immediately disinfected. 
Contaminated water supply is a frequent source of the 
disease, milk also may convey it ; if disinfection is not 
complete and the excreta is allowed to dry it may be 
transmitted through the air, or if the attendants are 
careless about personal cleanliness they may contract 
it themselves and infect other persons. With all these 



INFECTION AND CONTAGION 143 

avenues of infection, typhoid fever is not regarded 
as a disease which requires isolation, and cleanliness, 
and rigid and immediate disinfection, are considered 
efficient safeguards. 

At the outbreak of a case of typhoid, the source 
of infection should be traced if possible, because the Trace th f 

. . source of 

cases can multiply almost indefinitely, if the cause is infection 
not removed. Persons of all ages are susceptible to the 
disease, but it is most common between the ages of 
fifteen and twenty-five years. 

The period of incubation is generally placed at two 
weeks, although this varies, as do nearly all of the so- Monitory 
called typical symptoms. During ' this time there is symp oms 
usually a feeling of languor, slight pain in the abdo- 
men, a cough, occasional nosebleed, and an increasing 
sense of exhaustion, with finally very severe headache. 
In many cases the symptoms during the first few days 
are not marked enough to have necessitated the aid of 
a physician, but if he is called he will probably find 
that the fever is gradually growing higher each even- 
ing, till it reaches 103 or 104 . 

During the second week, the temperature remains 
high, and the pulse rate increases proportionately, and The second 
all the symptoms are aggravated. The listlessness gen- week 
erally increases, and with the continued- high tempera- 
ture delirium is often present. 

The bowels mav be constipated throughout the dis- _ . , 

. . Disinfec- 

ease, or there mav be diarrhoea, but in either case the tion of 

stools. 

disinfection of the stools must be carried out with con- 
scientious vigilance. 

The tongue and teeth become coated with sordes, 
which must be removed bv careful washing. It col- Care of 

mouth 

lects very rapidly, but cleanliness is one of the first and teeth 
requisites in the care of this disease, and with the 
proper solutions this deposit can be removed. 



144 



HOME NURSING 



Character- 
istics of 
the disease 



Devices 
for clean- 
liness 



Meeting 
specific 
needs of 
the case 



The small cloths and the swabs used to wash out 
the mouth must be wrapped in a piece of paper and 
burned and the attendant's hands must be washed 
in the disinfectant after this or any other service 
which brings them into contact with the body of the 
patient. 

The characteristic rash on the abdomen appears at 
about the end of the first or the beginning of the sec- 
ond week, and there is generally considerable distention, 
with tenderness over the right side. During this week, 
and the third, the weakness and emaciation increase, 
and the prostration becomes more marked. The pa- 
tient is often in a deep stupor, lying on his back, with 
the muscles relaxed, and it is difficult to arouse him 
enough for feeding, and to turn him for the necessary 
bathing. 

There are very liable to be at this time involuntary 
passages of urine and feces, and the bed should be 
thoroughly protected. Pads made, of thickly folded 
newspaper covered with waste absorbent cotton and 
cheesecloth or old muslin can be kept directly under 
the patient and are easily removed and burned. Often 
they prevent the bed from becoming soiled, and as 
they can be at once burned they remove some of the 
burden of disinfection and laundry. 

The amount of food and water must be kept up, 
even if the patient has to be fed only a teaspoon at a 
time, and a stimulant will probably be ordered, for the 
heart is overworked, and must be taken care of. 
Unless absolute rest is ordered, as in the case of hem- 
orrhage from the bowels, a patient must be turned on 
his side several times a day, supported by a pillow 
pushed in at his back, and rubbed and bathed to stim- 
ulate the circulation. In his depressed condition bed 
sores are very liable to appear, and a form of pneu- 



INFECTION AND CONTAGION 145 

monia may be caused if the position on the back is 
constantly maintained. 

The aim of those caring for a case of typhoid should 
be chiefly to place the patient under the best possible Aim of 
hygienic conditions, to supply him with suitable food, i ng the 
so that Nature can carry on her work of healing, patient* 
and to keep him from becoming a source of infection. 
It is to the nurse that the details of this treatment 
are left, and in no disease is the nursing more 
responsible for results. Orders must be followed 
absolutely. 

Rest in bed means that the patient must never sit 
up even, unless the physician permits it. Liquid diet *?. est and 
does not allow an occasional deviation, even after con- 
valescence, unless the change is ordered. 

Baths to reduce temperature are generally ordered. 
These vary from the simple alcohol sponging to the 
tub bath, which is in most cases rather too exhausting, 
and is always impracticable in a private house. The 
tepid or slightlv warm sponsfinsr is as beneficial as one How to 

• • ,, i , .- rr , 1 • bathe the 

given ice-cold, and the patient offers much less resis- typhoid 
tance. A very good plan is to have a large rubber patient 
sheet the length of the bed, and at least half as wide; 
cover this with a cotton sheet, and spread it under the 
patient, using the method described in changing bed- 
ding on pages 31 and 32. Large bath towels may be 
used to cover him, and a portion of his body is ex- 
posed at a time. A large face cloth or a sponge is filled 
with water and the body is rubbed with long gentle 
strokes, letting the water trickle down on the rubber 
sheet. With this protection an abundance of water 
can be used, and the body allowed to dry off, instead 
of being rubbed with a towel. Such baths are gener- 
ally ordered every three or four hours, while the tem- 
perature is high, and one for cleansing will be nec- 
7 Vol. 3 



146 HOME NURSING 

essary each day, for the function of the skin is strong- 
ly affected by the diseased condition. 

During the fourth week the fever begins to lessen, 

Dangers the brain grows clearer, and all the symptoms subside. 

vaiescence With the decline of the fever the appetite begins to 
return and the most trying period of the disease com- 
mences. Additions to the diet must be made with 
great caution, since many relapses have been caused 
by injudicious feeding. The hunger is all-absorbing, 
and the patient is often so unreasonable that it is very 
difficult to be firm and to remember the dangers. 

ERYSIPELAS 

Erysipelas is an infectious disease, characterized by 
Character an intensely inflammatory condition, generally confined 

and cause ,. . , .... - . . , ,.,, , 

of ery- to a limited area, ordinarily ushered in by a chill, and 
sipeas accompanied by high fever. It is believed that the 
poison gains access to the body through an abrasion 
or tiny scratch, and an open wound is especially liable 
to become infected. The affected area is swollen, red 
and shiny, its margins are distinct and raised, and it 
extends rapidly. Small blisters form on the surface 
and fill with fluid by which the germ of the disease 
may be conveyed. After the inflammation has sub- 
sided, desquamation takes place, and at this time, too, 
special care must be taken to prevent the spread of the 
contagion. Soothing applications will be ordered to 
its conta- relieve the burning and pain, the diet must be nutri- 
care a tious and easy of digestion, and very often there will 
be need of stimulant to support the strength. In order 
to prevent the transmission of the infection, the pa- 
tient should be isolated, all dressings used about him 
must be promptly burned, and his bed-linen must be 
disinfected. 



INFECTION AND CONTAGION 147 

MALARIAL FEVER 

The discovery of the source of malarial infection 

has made more difference in its prevention than in its Protection 

i • • • 1 o£ the 

treatment, although as the investigations proceed re- malarial 

suits along these lines will be attained. The bacteria froITmos- 
are found only in the blood of patients, so no isolation <i ultoes 
or disinfection is required. Since infected mosquitoes 
convey the disease, the patient must be as rigidly pro- 
tected from them as a person who is hoping to avoid 
contracting it. The reason why quinine has usually 
such a powerful effect is believed to be because it is 
poisonous to that specific germ, causing its destruction 
or rendering it harmless. 

The chief characteristic of malaria is the periodic at- 
tacks which are generally described as chills, but which Character- 
really include three stages : The cold feeling, with malaria 
shivering and chattering of the teeth, introduces the 
attack, a period of intense fever follows, after which 
comes the sweating stage. These attacks recur at 
regular intervals, which may differ with the disease, 
returning every twenty-four, forty-eight, or seventy- 
two hours. While the fever is in progress the recur- 
rence is uniform, the attacks appearing at the same 
hour. If it is increasing in severity, the intervals are 
shortened by half an hour or an hour, and if it 
is becoming more mild, they are correspondingly 
lengthened. 

The severity of the chills may be somewhat les- 
sened if the patient goes to bed shortly before the at- Treatment 
tack is expected, is warmly covered with blankets, sur- malarial 
rounded with hot-water bottles, and is given a hot patient 
drink. When the fever comes on, the covering may 
be removed, cold drinks will be refreshing, and cool 
sponging will give relief, and may keep the temper- 



148 



HOME NURSING 



Definition 
of dysen- 
teric con- 
ditions 



Care and 
treatment 
of the 
patient 



ature down somewhat. In the third stage the per- 
spiration must be wiped away with warm cloths, and 
after it is over and the patient has rested, a warm soap 
and water bath will be needed. If medication is being 
given, purgatives must not be given without doctor's 
orders, as they have the effect of clearing the system, 
and may thus rid it of the drug before it has done its 
work. 

DYSENTERY 

An inflammatory condition of the intestinal lining 
leads to a form of diarrhoea called dysentery. There is 
usually some abdominal pain and tenderness and slight 
fever at the beginning of an attack, and a character- 
istic symptom is the continual desire to strain, which 
is called tenesmus. Mucus and blood are present in 
the stools, and the freqtfent movements exhaust the 
strength of a patient. 

Rest in bed is necessary, fluid diet, which may be 
rice-water or arrow-root gruel, is ordered, and the pa- 
tient must be kept warm, and must be on the back as 
much as possible. Cool compresses applied to the 
anus often relieve the tenesmus, and starch injections 
sometimes soothe the irritation of the bowels. The 
starch is mixed with cold water, then enough boiling 
water is added to make a thin paste, which will flow 
easily through rubber tubing, and it is brought to body 
temperature. 

The injection is usually given with a soft rubber 
catheter, a funnel receiving the mixture and leading 
it into the tube, and not more than four ounces need 
be used. The starch solution should be retained in the 
bowel, and the irritation is so extreme that any undue 
pressure would cause it to be expelled, so less, rather 
than more, should be given. 

The stools have a very offensive odor, quite differ- 



INFECTION AND CONTAGION 149 

ent from that of ordinary healthy feces, and this may 
be somewhat overcome by the free use of chloride of 
lime. The micro-organism causing dysentery is con- Disinfec- 
fined to the intestine, so that strict disinfection is nee- the dysen- 
essary. The rectal tube or catheter, as well as the afte r and 
bed-pan, should also be disinfected after use, and 
boiled at the termination of disease, and the same care 
must be given the soiled linen. It is well to keep the 
tube in a carbolic solution, which does not injure the 
rubber, and effectually destroys the germs. The 
catheter must be carefully rinsed before it is used 
again, since carbolic, even in a diluted form, is ex- 
tremely irritating to mucous surfaces. The abdomen 
should be protected by a flannel bandage, and especial 
care should be taken with ventilation. 



IX 

INFECTIOUS DISEASES 

(CONTINUED) 

Influenza — Pneumonia — Tuberculosis— Forms of the Disease— Heredity- 
Channels of Infection— General Precautions— Special Precautions for At- 
tendants — Exercises Beneficial to Those with Tendency to Tuberculosis — 
Suggestions for Patients— Care of Patients— Cerebro-Spinal Meningitis 



Bacterial 
origin of 
influenza 



INFLUENZA 

INFLUENZA has also been proved to be a disease of 
bacterial origin. Epidemics of influenza are fre- 
quent, and their results are so varied that it is hardly- 
possible to predict what course the disease may run. 
The initial symptoms are usually those of a heavy 
cold, but with an excessive soreness of the limbs and 
body, and with a marked mental depression. The 
particular danger lies in the fact that so often there 
are serious complications, or that a person is left 
with a weakness in the system which causes the de- 
velopment of disease. The infection is probably con- 
veyed in the nasal and throat discharges, and is 
received in the air which is breathed. 

No means of prevention has been found effective, 
but since most of the serious consequences have been 
caused by too short a period of convalescence, rest in 
bed would seem to be a necessary precaution. A great 
Safeguard- deal of relief from the bruised feeling of the body can 
p2ient be gained by rubbing, and cold or hot compresses gen- 
erally quiet the headache, so that sleep is possible. 
The weakness will be found to last for a long time, 
and the strength should not be forced or taxed un- 
duly. 

(150) 



How the 
infection 
is con- 
veyed 



INFECTIOUS DISEASES 151 

A change of air, strict attention to hygiene, nour- 
ishing diet, and rest, will be found most helpful in 
restoring health. 

PNEUMONIA 
The infectious nature of pneumonia has been un- _ . 

r t Infectious 

mistakably proved, and the importance of careful dis- nature of 

. ... ., . , pneumonia 

intection is now more generally recognized as necessary 
to prevent the spread of the disease. It has taken the 
epidemic form in so many instances that even those 
to whom the results of bacteriological investigations 
are unknown must be convinced that it is one of the 
communicable disorders. 

The germ is contained in the sputum, which must 
therefore be received in moist cloths or in an especially disin- 
prepared receptacle and burned or disinfected. In all fectl0n 
cases where there is abundant discharge from the nose, 
throat, or lungs, whether it be a simple catarrhal cold 
or tuberculosis, hygiene demands this precaution. The 
washing of handkerchiefs, so soiled, should never be 
required of any one, and they may carry latent germs 
of disease before its presence is recognized in the pa- 
tient. 

Pneumonia is inflammation of the lung tissues. 
It generally is confined to the right lung, but both may bacteria of 
be involved. It is caused bv exposure to cold, or to P ne " monia 

J r work 

sudden variations of temperature, and generally un- 
healthy surroundings predispose one to it. The bac- 
teria causing it are confined to the lung substance, but 
the poisons which they produce are taken over the sys- 
tem in the blood stream, causing the general constitu- 
tional symptoms. 

In the first stage, the affected part of the lung be- 
comes gradually filled with a secretion which in the fhediseale 
second becomes consolidated. In the third stage, if the 



152 HOME NURSING 

disease is progressing to a favorable termination, res- 
olution, or the "gradual restoration of an inflamed part 
to a normal condition," takes places. 

The disease commonly begins with a chill, and a 
sudden sharp pain through the affected side. Its 
nhf in of P ro g" ress i s ver y rapid, the pulse and temperature 
pneumonia mounting within a few hours, and the respiration soon 
becoming labored and shallow, with the characteristic 
dilation of the nostrils. With the fever so high, and 
extra activity demanded from the heart and the respir- 
atory centres, the prostration is extreme. Fluid diet, 
generally milk and broth, must be given with regularity, 
in the proportion of a coffee-cup every three hours. 
The intervals, and the amounts, may have to be les- 
sened, and if the patient sleeps during the night he will 
probably not be disturbed. The stomach must not be 
overloaded, since that throws more work upon the 
entire system, and the vitality is everywhere at low ebb. 
The chief danger lies in the failure of the heart from 
overwork. 

The cough is at first dry and hacking, causing severe 

pain in the chest, and the sputum is scanty. Later, 

Jp° u u t ^ and the cough becomes looser, and the expectoration is 

more abundant, and of a characteristic rusty color, 

caused by the blood which streaks it. 

Between the third and tenth days, the temperature 
suddenly drops, sometimes from 103 or 104° to 98°, 
When the or even lower. With this loss of fever, there is usually 
disappears profuse perspiration and excessive weakness. The pa- 
tient must be saved long exertion now, and the pulse 
must be watched carefully. 

The chill of clothing, damp with the perspiration, 
is very unpleasant, and also the danger of catching 
cold, which is very slight when the fever is high, in- 
creases. The exertion of making changes as frequently 



INFECTIOUS DISEASES 153 

as would be necessary is unsafe, but if small bath Careful at- 
tcwels or pieces of thin blanket are heated and laid clothing 
next the skin over back and front, and changed as soon f^" ° t ur " 
as they become damp or cold, it will lessen discomfort, 
restore the heat of the body, and thus serve as a slight 
stimulant. The nourishment during this stage should 
be given hot, on account of its action on the heart. 
The dangers of this period past, the patient goes on 
to rapid recovery. 

Convalescence is usually uneventful, with a sur- 
prisingly quick return of strength. A patient recover- Convaies- 
ing from pneumonia must guard against exposure, as a nd P re- 
there will be increased susceptibility for some months. Against S 

Young children are very liable to have brain exposure 
complications in an attack, and if a person has used 
alcohol to excess his chances of recovery are mate- 
rially lessened. 

TUBERCULOSIS 

Tuberculosis has been called ''The Great White 
Plague," and in view of the fact that it is a disease The great- 
which attacks all ages, in all countries, that it is re- ^modern 
sponsible for every sixth or seventh death, that yearly times 
in the United States one hundred thousand persons are 
swept away by its ravages, it may well be pronounced 
the greatest scourge of modern times. 

Tuberculosis often accompanies or unfavorably in- 
fluences other diseases, and the fact that it is latent in Bacterial 
the system is often the cause of the slow recovery or ongm 
possibly fatal result of seemingly mild disorders. The 
disease is of bacterial origin, being caused by the en- 
trance into the system of a particular form of microbe, 
known as the tubercular bacillus, from its rod-like ap- 
pearance when seen under the microscope. 

If this germ finds the soil suitable for its growth, 



154 HOME NURSING 

it multiplies rapidly, and causes the formation of tuber- 
cles upon whatever tissue it attacks. These tubercles 

How the have a tendency to spread and break down, causing, 
first, interference with the functions of the part af- 
fected, and second, almost certain systemic involve- 
ment. 

Tuberculosis may be regarded as an infectious or 

How it communicable disease, rather than a contagious one, 

is com- ° . 

municated prolonged exposure under certain favorable conditions 
generally being necessary to its transmission. If the 
sputum and other discharges of tuberculous patients, 
which contain millions of the dangerous bacteria, are 
properly taken care of, there is very little danger in 
being in contact with them. 

Nature has provided two safeguards, for us 

Nature's against the invasion of the disease. The nasal secre- 
tions when in normal condition are destructive to the 
germs before they can enter the lungs. Also the blood, 
we can remember, is composed in part of white cor- 
puscles, whose province it is to wage warfare against 
dangerous parasites, and destroy them. 

FORMS OF THE DISEASE 

The most frequent form of the disease is pulmo- 

Acute and nary tuberculosis or phthisis, in which the lung tissue is 

formT C of attacked. The disease may be either acute or chronic. 

the disease j n fa e ear iy stages of the former, the portions of the 

lung invaded by the bacillus become consolidated and 

later break down, leaving cavities. The acute form is 

usually rapidly fatal, but in chronic cases the disease 

is frequently arrested. 

In either, the great danger of infection is from the 
The dan- sputum, which is charged with many millions of bacilli, 
lection Tnd which, if once set free and allowed to become dry, min- 
symptoms gj e w j t j 1 foe <i us t and may be inhaled by susceptible per- 



INFECTIOUS DISEASES 155 

sons and set up the disease. The symptoms are cough, 
expectoration, pains in the chest, loss of appetite, grad- 
ual but steady decrease in weight, night-sweats, and 
slight rise of temperature toward evening. Tubercu- 
losis mar develop in various parts of the bodv, no tis- The dj s- 

• . • rr^, eaSe i 11 

sues being exempt from its invasion. The more com- various 
mon points of attack are the throat, the uterus, the {-h^Ldy 
joints and bones, and the skin. Tuberculosis of the skin 
is known as lupus. 

HEREDITY 

The popular theory of the transmission of tubercu- 
losis from parent to child is fast losing- its hold upon Predispo- 

• r- • -1111 sition to- 

the scientific world, and experience is day by day bear- ward the 
ing out the conclusions against it. There is, however, ^nTT 
a marked tendency or predisposition toward the dis- weak body 
ease in the offspring of tubercular parents, which 
must be reckoned with. The child comes into the 
world with the inheritance of a frail body, in many 
cases with a narrow chest and poor circulation, with 
little fondness for out-of-door sports, and it may be 
with no attention paid to securing for him an active 
and healthy body. What wonder then that the seeds 
of disease early find access to his body, and suitable 
soil for development there, or that he should be thought 
to have inherited the disease directly from his parents? 
Especially is this true when one child after another 
in the same family sickens and dies with the disease. 
It is, however, the belief held by most of the noted why the 
scientists of to-day that the tubercle bacillus does not sickens 
exist at birth in the body of a child born of parents 
one or both of whom may be victims of tuberculosis, 
but that it may find ready access by means of the im- 
paired vitality forced upon the child by such parentage 
is easily conceded. 



156 



HOME NURSING 



How the 
child may 
be safe- 
guarded 



It is a comforting thought following this theory 
that parents can in very many cases successfully protect 
their children against the disease once thought to be 
almost inevitably in store for them. By careful selec- 
tion of every means to secure the best hygienic sur- 
roundings and the stoutest and most vigorous state of 
health, both bodily and mental, many children pass 
through the precarious period of childhood and ap- 
proach adult life well equipped for warding off the 
disease. 

There must, however, be extreme care on the part 
of the parent, and oftentimes special precautions ex- 
ercised by the child against the disease. 



The first 
channel 
through 
the lungs 



The sec- 
ond way 
of infec- 
tion 

through 
the alimen- 
tary canal 



CHANNELS OF INFECTION 

Infection by the tubercle bacillus may take place in 
one of three ways : namely, by inhalation, ingestion, or 
inoculation. 

The first is the commonest way. It is the breath- 
ing into the lungs the particles of dried sputum or 
other discharges which have become mixed with the 
dust. 

These same particles sometimes become mixed with 
food or drink, and enter the alimentary canal, which 
forms the second mode of infection. Carelessness in 
carrying the hands to the mouth after handling soiled 
linen is another means of communicating the disease. 
Sometimes a tubercular patient in sneezing or laugh- 
ing expels a particle of saliva which may contain the 
bacilli, and one is not safe who is facing him at a 
shorter distance than three feet, as these particles may 
be inhaled or swallowed. Another source is through 
infected milk or meat, particularly the former, which 
should always be sterilized if it comes from a suspicious 
source. 



INFECTIOUS DISEASES 157 

The third and less common method of infection is The third 
by inoculation through a scratch or slight wound, through 
This is liable to occur at any -time when the hands ^wound 
come in contact with tuberculous matter, hence any 
abrasion on the hands should always be protected. 

GENERAL PRECAUTIONS 

There are general precautions against the increase 
of tuberculosis, which can be of great value only when 
all intelligent people feel their force and combine in 
checking the ravages of the dreadful disease. 

(i) The better ventilation of schools, factories, The P re - 

v ' caution of 

offices, and public buildings. ventilation 

(2) More attention to the physical well-being and Attention 

. . r j_i to physical 

development 01 youth. well-being 

(3) The selection of better foods and their prepa- Better 
ration under more sanitary conditions. foods'* 

(4) The limiting of occupations that tend to the sanitary 

development of the disease. Sonsin oc- 

cupations 

PRECAUTIONS FOR ATTENDANTS 

(1) The sputum must be prevented from drying. 

The sputum mug should be partially filled with some care of 
disinfectant fluid, or, if necessary, moist rags can be and^dTsin- 
used, and burned before thev have a chance to drv. fection of 

sputum 

Sputum mugs that are cracked or nicked should never mugs 
be used, as germs will get into the crevices and be- 
come a source of danger. Any such receptacle should 
be of metal, china, or glass, so that it can be boiled. 
A pair of rubber gloves is very useful to slip on when 
washing these mugs. 

(2) The patient's linen should be placed in a dis- Disinfec- 
infectant or boiled before mixing with the general body 
laundry. linen 

(3) Dishes used by the patient should be kept sep- 



158 HOME NURSING 

Disinfec- arate from those for family use, and should be boiled 

tion of j. ... 

dishes frequently. 

(4) The patient should be instructed always to 
Duty of -hold a handkerchief before his mouth when coughing 

the patient . P ° 

or sneezing, so as to avoid any danger from particles 
of mucus that might be expelled at the time. 

(5) Dust cloths should always be moist, and must 
Dusting be burned or boiled or soaked in a disinfectant after 
fng the using. The floor should never be swept, but should 
?oom nt ' S ^e wiped, also with a moist cloth. A carpet must not 

be allowed to remain on the floor. 

There are various ways by which one who has the 
How the care f a tuberculous patient can guard her health, 

home nurse . .. . ° 

of a tuber- and it is most important that every effort toward 
tient US must maintaining a healthy condition of body and mind be 
ne^health ma de, if one is to ward off infection successfully. 

A person who is weakened physically from any 
cause should never be allowed to undertake the nurs- 
ing in any infectious disease, and there must be regular 
hours for food and rest if the health is to be main- 
tained. One should never go hungry to the sick- 
room, and at all times the body is to be well nourished. 
Plenty of out-of-door exercise is essential, and at 
times when this is not practicable it may be substi- 
tuted by breathing exercises taken before an open 
window. Deep breathing which admits plenty of 
oxygen to the lungs is an excellent method of pre- 
venting tuberculosis. 

EXERCISES BENEFICIAL TO THOSE WITH TEN- 
DENCY TO TUBERCULOSIS 

The following exercises will be found of very great 

Loose benefit to one having a tendency to tuberculosis or to 

f oth / s "f e a those who may be especially exposed to it. A person 

with tightly fitted neckwear or tight clothing can 



INFECTIOUS DISEASES 159 

never breathe properly. There should always be per- 
fect freedom about the neck, chest, and abdomen. 

Heels together, head erect, chest forward, hips 
thrown back, the arms hanging at the sides with the First sim- 
palms turned in. With mouth closed take a deep c ise in 
inspiration, and hold the breath for a few seconds, ^atiiing 
then exhale slowly. Next during the act of inspira- 
tion raise the arms slowly to a horizontal position, 
keep them there while holding the breath a few sec- 
onds, and then gradually lower them as the breath is 
exhaled. The act of expiration should always be a 
little more rapid than that of inspiration. 

The second exercise is like the first except that 
the arms are carried up over the head in a vertical Second 

r _ exercise 

position till the tips of the fingers meet over it. 

With the same military attitude as at first, the 
arms are extended at full length in front of the body Third 
in a horizontal position and with the backs of the n 'cuit ex- 
hands meeting as in the act of swimming. The arms ercise 
are then moved as if dividing the water during in 
spiration till the hands meet behind the back. The 
breath is then held for a few seconds, and the arms 
are carried forward during exhalation. 

The arms should not be allowed to drop out of the 
horizontal position at any time. This exercise is made 
easier by rising on the toes during expiration. 

To overcome the habit of stooping, the following 
exercise is recommended : Military position, hands on To ° ver - 
hips with thumbs in front, then slowly bend back as habit of 
far as possible during inhalation. Remain in this stooping 
position a few seconds while holding the breath, and 
then rise during the act of exhalation. These exer- 
cises should not be begun too vigorously. 

It is better to commence with the simple exercises, 
reserving the more difficult until the others have been 



with 
patient 



160 HOME NURSING 

Never use practiced for several days. They should never be 
dis^hen taken when one is very tired, and should not be kept 
tired U p un tii one becomes so. They should be taken 

several times a day, and by their continued use deep 
breathing will soon become a habit. Breathing exer- 
Nor with- c i seSj though very useful to tuberculous patients when 
physician's properly directed, should on no account be taken un- 
advisedly nor without the guidance of the physician 
in charge. 

A person having the care of a tuberculous case 

Caution should on no account sleep in the same bed with the 

sleeping patient, nor occupy the same room at night if it is 

possible to avoid it. A couch placed in the hall just 

outside the door of the room can usually be arranged 

for use at night, and is invariably to be preferred. 

SUGGESTIONS FOR PATIENTS 

The matter of expectoration and facilities for the 
How to disposal of the sputum has received much attention, 
and ry use and a number of devices have been arranged for the 
sputum* use °^ consumptives. A very satisfactory receptacle 
flask f or a patient who is not confined to the bed or chair 

is a pocket flask, which is unbreakable and can be 
easily cleaned. One made of metal and containing a 
movable funnel is perhaps one of the best. It can be 
placed inside an ordinary pocket-handkerchief with an 
elastic band placed round the neck of the flask, out- 
side of the handkerchief, to keep it in place, and as 
it can be easily manipulated with one hand it is used 
without attracting attention. 

For street use there have been devised some self- 

Pocket cleaning spittoons which it is desirable should be 

cups U for placed freely in all large cities. Pocket receptacles 

street use ma y be obtained at any large drug store or ordered 

if they are not in stock. Patients who refuse to use 



INFECTIOUS DISEASES 



161 



portable sputum cups should have a pocket lined with 
rubber in which they can place the cloths used, and 
these must be burned before they become dry. 

There are some ways in which a patient can guard 
against re-infection of himself, and this is very neces- Guarding 

• 11 •<> i • mi -i- against re- 

sary, especially if the case is a mild one and the dis • infection 
ease confined to a limited area. He should never 
swallow the sputum to avoid expectoration, as in this 




Pocket Sputum Flask 



way the bacilli are carried directly to the intestines, 
which sooner or later are sure to become infected. 
He should always carry two handkerchiefs, one for 
wiping the mouth and another for the nose, so that 
there can be no danger of the infection being carried 
to the nasal passages and thence to the throat. 

As a safeguard for himself and others he should 
be careful not to caress household animals, which Germ-car- 

rying furs 

frequently carry the germs from one person to an- 
other in their fur. 



162 HOME NURSING 



CARE OF PATIENTS 

The diet of tuberculous patients should be en- 
vvhat the tirely wholesome, and as hearty as is practicable with 
ious r pa- the condition of the digestion. Scraped beef, milk, 
Ihouid eat whole-wheat bread, and raw eggs should be given in 
abundance. A fresh raw egg can be made very pal- 
atable if it is dropped carefully into a glass contain- 
ing a little lemon- juice, sprinkled with a little pepper 
and salt, and covered with more lemon squeezed 
over it. Sherry wine is sometimes used in place of 
lemon- juice. 

In conclusion let us add that the message of the 
Tubercu- scientific world along the line of the tuberculosis in- 
curable vestigation is full of cheer and confidence provided 
there is obedience to simple hygienic rules. This is 
what the sanatoria are trying, and with already a 
marked degree of success, to set before us. Tuber- 
culosis is both a preventable and a curable disease. 
There is no specific climate necessary for its 
No specific treatment, although some climates may have a better 
chmate influence than others upon it. 

There is no specific medicine which can act di- 
.*o specific rectly upon the germ causing the disease, or upon the 
poisons which that germ produces. The attitude of 
the medical world toward the segregation of tuber- 
culous patients has changed from that of indifference 
or even hostility to one of hearty indorsement of the 
methods carried out by the modern sanatoria. 

The principles of treatment there adopted are : Life 
Principles spent in the open air, the nutrition of the body main- 
ment eat tained at the highest point, and rest suited to the 
patient's condition and to the stage of the disease. 

An arrangement for carrying out home treatment 
on the sanatorium basis is often practicable, when for 



INFECTIOUS DISEASES 163 

some reason it is not advisable or necessary to send 
the patient away. A veranda can be built on, conven- To have 
ient to the patient's living-room, where *he can rest sanato- 
dnring the day and can often sleep during the night. rmm 
This should be covered by a roof or awning, and in 
most climates it will need to be inclosed in wire 
netting as a protection against mosquitoes and flies. 
The reclining-chair may be of willow or an ordinary 
steamer-chair well cushioned will answer the purpose. 

If the clothing is warm, and hot-water bags are Duringthe 
used at the feet and about the bodv, a person can live winter 

J ' r months ' 

out of doors in really cold weather. A very good 
arrangement for protecting one from draughts is a 
beach-chair with high back and sides, like the old 
sedan-chairs. If the seat is taken out of this and the 
head of the steamer-chair is drawn inside it, the head 
and shoulders can be effectually protected from 
draughts, and yet the lower part of the body may lie 
in the sun. This is a better arrangement than shield- 
ing the patient with an ordinary screen, because the 
chair is stable and solid and can not be blown over. 
It may not be necessary for a person to give up 
all occupation, and to become a helpless invalid. If one's occu- 

. . . pation in 

tuberculosis is recognized in its incipient stage it is case of 
inclined to yield quickly to treatment. If the patient los" "" 
has an indoor occupation, if he is working in an 
atmosphere which is carrying foreign particles into 
his lungs with every breath he draws, his first duty is 
to find, another method of earning his living. Every 
year increases the number of persons who are fight- 
ing the disease, or a tendency to it, by giving the 
tangs a chance to expand in the fresh open air and by 
furnishing the tissues with the best possible nutri- 
ment, while at the same time the daily occupations of • 
life are carried on. 



164 HOME NURSING 

It is the neglect of the premonitory symptoms that 
Duty of makes the disease such a menace to patients contract- 
to himself: ing it, and it is their lack of observance of precau- 
community ti° ns that makes their presence in the community an 
actual danger. 



CEREBRO-SPINAL MENINGITIS 

Meningitis is an infectious disease, though the 
infectious- specific micro-organism producing it has not been 
meningitis isolated. In the highly malignant form of the disease 
there is hardly time to recognize the nature of the 
trouble before the end has come, but when the attack 
is milder it is less often fatal, but needs untiring and 
intelligent care. 

The excessive stiffness of the muscles of neck, 

Character- spine, and extremities, the deafness and headache are 

symptoms ver y characteristic of the disease. Dizziness, nausea, 

constipation, restlessness, delirium, and double-vision 

are usual accompaniments, the temperature is not 

necessarily high, and an eruption of the skin appears 

frequently enough to give the disease its name of 

''spotted fever." It generally occurs in epidemics, 

and attacks both children and adults, although it is 

more common during the first twenty years of life. 

The milder cases run for a period of from two to 

Conva- four weeks, convalescence being rather slow. The 

deafness, dizziness, and muscular stiffness last for 

some time and excitement and fatigue must be avoided. 

The different symptoms receive, individual treatment 

Treatment- as t h e y occur# if the temperature is high, sponge 

individual baths and rubbing with alcohol are given. The pains 

in the spine are treated with either cold or hot 

applications according as the system seems to need 

a depressant or a stimulant, and the restlessness and 



INFECTIOUS DISEASES 165 

delirium are often relieved by the use of an ice-bag 
on the head. 

As soon as the stomach can bear food it should be 
given with great regularity. Liquids will be ordered Diet 
while the fever continues, and during convalescence 
the diet should be abundant and easily digestible. All 
excitement should be guarded against, and every con- 
dition that makes for health should be secured. 

An inciting cause of the disease is believed to be 
poor food and bad air, combined with a depressed state 
of the system, which furnishes a favorable condition 
for the growth of the disease germ. One point that 
we must emphasize in our treatment of the disease The dis- 
is the fact that it is communicable from person to commu- 
person. The nasal and throat secretions should be mca 
disinfected or received in cloths which can be burned, 
and the utmost care should be taken in regard to per- 
sonal cleanliness and the care of utensils. Good 
health, fresh air, and suitable nourishing: food are the Necessary 

safeg«ards 

best safeguards. Mild cases when neglected may 
leave the system in a condition of increased suscep- 
tibility to subsequent attacks, or a deficiency in the 
sense organs causing deafness, loss of the use of the 
vocal cords, or both. 



X 



ACUTE AND NERVOUS DISEASES 



Rheumatism— Tonsilitis— Bronchitis — Pleurisy — Appendicitis— Bright's Dis- 
ease— Neurasthenia— Hysteria— Epilegsy— Insanity 



Inflamma- 
tory na- 
ture of 
rheuma- 
tism 



Care 
of the 
clothing 



Precau- 
tion in 
bathing 



RHEUMATISM 

ACUTE inflammatory rheumatism is a disease 
characterized by pain and swelling of the joints, 
accompanied by high fever. Usually one joint after 
another becomes involved, and in severe cases the 
pain is extreme, so that even the weight of the sheet 
on the affected parts is intolerable and the slightest 
jarring of the bed or change of position causes ago- 
nizing pain. The disease is usually brought on by ex- 
posure to damp and cold and generally runs a course 
of several weeks. 

Profuse perspiration accompanies the disease, and 
the clothing must be changed as it becomes wet with 
the increased moisture of the body. For this reason 
a night-dress opening down the back which can be 
slipped on and off the patient with the least possible 
disturbance is essential for such cases. A thin flannel 
shirt opened down the back in the same way should 
be worn next the skin unless a flannel night-dress is 
preferred. 

The advisability of giving the daily bath must be 
left for the doctor to decide. As the perspiration is 
always profuse, and has a characteristically strong 
odor, there should be frequent sponging with warm 
alcohol. All bathing should be done under cover 
without the slightest exposure. 
(166) 



ACUTE AND NERVOUS DISEASES 167 

The danger of bed-sores forming should be particu- 
larly kept in mind. The increased moisture, owing to The dan- 
profuse perspiration, and the patient's inability to turn bed-s°ores 
himself are exciting causes which might readily lead 
to bed-sores if special care is not taken to prevent 
their formation. 

Rheumatic cases are always liable to heart com- 
plications and care must be taken not to move a The action 

r of the 

patient suddenly or as he improves to allow him to heart 
make any sudden exertion. Sometimes even after 
convalescence seems well established the heart func- 
tion is still imperfect, and may remain so for some 
weeks or months, if, indeed, the patient is not left 
with a chronic weakness of that organ. On this ac- 
count any orders the doctor may give in regard to 
rest and careful exercise need not seem unreason- 
able. 

There is likely to be great irritability of the nerv- 
ous system and often marked mental depression. Dis- Reguia- 
taste for food as in all fever cases may be expected, the" diet 
and ingenuity and untiring patience in preventing it 
is demanded of the nurse in order to keep up the 
necessary amount. The diet in rheumatism is always 
carefully regulated. During the fever stage nothing 
but liquids in liberal quantity may be given. As the 
fever declines light diet is allowed, though all foods 
having a tendency to produce acids in the system must 
be eliminated. 

In general the following diet list may be useful 
during convalescence : Eggs in moderation, small A diet 

• • r r • r , , . , r list for a 

quantities of farinaceous foods, toast, stale bread of rheumatic 
rye or whole wheat flour, milk toast, zwieback, gra- patient 
ham gems, crackers, and hominy. Vegetables — 
fresh green varieties, celery, lettuce, watercress, sal- 
ads, young peas and beans, and spinach. For des- 



168 



HOME NURSING 



A bever- 
age list 



A device 
for relief 



serts — oranges, lemons, cranberries, apples, apricots, 
pears, peaches, cherries, jellies, blanc-mange, stewed 
or roasted fruit. Meat should be taken once a day 
only, and should be confined to the white varieties 
chiefly — mutton, chicken, bacon, sweetbread, pigeon, 
and pig's feet. 

Beverages will be useful during the fever to re- 
lieve the great thirst, and a plentiful amount of liquids 
assists toward recovery. Plain soda, toast-water, 
lime-juice, lemonade, and mineral waters may be given 
with the doctor's approval. Liquids should be taken 
through a glass drinking-tube, which it is necessary 
to wash at once after using in order to keep it clean, 
unless a small brush is used which serves to properly 
clean the inside of the tube. 

In cases of chronic rheumatism, pain may some- 
times be greatly relieved by wrapping the joints in 
cotton wool. If there is a slight rheumatic tendency 
and the joints feel stiff and painful in the morning, 
the use of cotton over the affected part frequently 
puts an end to the trouble. 



Marks of 
tonsilitis 



TONSILITIS 

Inflammation of the tonsils often follows exposure 
to cold, fatigue, or foul and poisonous air. Although 
not usually in itself a serious affection, it is extremely 
prostrating and is attended by high fever, severe 
headache, and general soreness of the limbs and back. 
The tonsils themselves become enlarged, so that talk- 
ing is difficult and the voice sounds thick. The glands 
about the neck are also more or less swollen. The 
white spots seen on the tonsils may be confused with 
the gray patches of diphtheria, though the distinction 
is usually recognizable to a practiced eye. No posi- 
tive diagnosis, however, is likely to be made if there 



ACUTE AND NERVOUS DISEASES 169 

is any doubt in the matter until a "culture" has been 
taken from the throat and subjected to examination 
under the microscope. This is now a routine measure 
with many physicians whenever the throat is affected. 
The patient should be- kept in bed and on liquid 
diet, and a gargle prepared for the relief of the in- Care and 

, . . r i i -rr • , • treatment 

named tissue of the throat. If no special prescrip- of the 
tion is given by the physician one made of hamamelis patient 1C 
diluted half with water is useful because of its slightly 
astringent property. If the area of white patches is 
large in the throat a solution of peroxide of hydrogen 
one part in six of water will aid in cleansing the 
throat. 

Special care must be observed to keep an even 
temperature in the sick-room, especially when the 
patient begins to sit up, as relapse sometimes brings 
with it serious complications. All dishes used by the 
patient should be kept separate from those of the 
family. 

The fever in tonsilitis is of short duration, but it 
is often several weeks before a person regains his 
usual strength after an attack. 

BRONCHITIS 

Bronchitis may follow a cold or occur as a symp- 
tom in the progress of other diseases. There is a Signs in 
feeling of tightness and soreness across the chest, a of bron- 
hard, dry cough often coming in severe paroxysms, chltls 
and, as in tonsilitis, the weakness and aching of the 
head, back, and limbs is marked. The fever does not 
run as high as in tonsilitis. In an ordinary case of 
bronchitis the cough may be expected to loosen in 
three or four days, and expectoration becomes freer, 
giving great relief. 

n The bowels should be kept open and free action 
8 \c\ 3 



170 



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Condition 
and care 
of the 
patient 



of the skin secured by means of the bed-bath and 
alcohol rubs. It is especially important that the air 
of the room should be kept pure and the temperature 
not above 70°, and that there be plenty of nourish- 
ing food. The patient must avoid sudden change of 
temperature in going from room to room when con- 
valescence begins, as the susceptibility to cold is in- 
creased. 



PLEURISY 



£? pleura OF injury 



The term pleurisy indicates an inflammation of 

what the the membrane or pleura which envelops the lungs. 

pleura is ^[ s me mbrane is so arranged as to fold back, form- 
ing also a lining to the chest cavity. In health it 
secretes a certain amount of fluid which serves to 
lubricate the two surfaces, so that they slide easily 
against each other as the chest rises and falls in 
breathing. 

Inflammation often occurs as a complication of 

infiamma- pulmonary disease or it may follow cold, exposure, 
The membranes become dry and no longer 
rub smoothly against each other, and this causes sharp 
pain on inspiration. This condition may terminate in 
a restoration to the normal state in a few days or 
continue for some weeks. 

Counter-irritants in the form of a hot-water bag 
or a mustard plaster, if applied immediately upon the 
first indication of pain, may sometimes ward off an 
attack and a broad band of adhesive plaster carried 
entirely around the chest to constrict its movements 
gives considerable relief. 

Sometimes the temperature continues to remain 

Conditions high and the breathing more or less difficult, though 
the pain lessens or may entirely disappear. These 
symptoms may mean that the space between the two 



Counter- 
irritants 



rf the 
fever 



ACUTE AND NERVOUS DISEASES 171 

surfaces of membrane is filling with fluid and their 
separation has caused the pain to diminish. This con- 
dition may subside gradually and the fluid become 
absorbed or pus may form and an operation become 
necessary. 

APPENDICITIS 

Appendicitis is an inflammation confined to a certain 
part of the intestines known as the vermiform ap- Causes of 
pendix. The disease was commonly called "inflam- citis 
mation of the bowels" before modern surgery showed 
that the origin of the trouble is in the appendix or 
small appendage on the right side of the intestines. 
Inflammation may be due to blows, falls, great physi- 
cal exertion, a strain, improper food, or to a small 
hardened mass — rarely to a foreign body — which may 
collect and obstruct the opening to the appendix. 
Sometimes it is associated with rheumatism, influ- 
enza, or typhoid fever. 

There are several forms of the disease recognized 
as acute, chronic, or recurrent. Sometimes it hap- Several 
pens that grave symptoms are obscured and the the'disease 
patient may not seem very ill, though in reality the 
condition is most serious. For this reason the advice 
of a physician should always be sought if there is 
any indication of the following symptoms : 

The pain may be sharp and colicky or dull and 
aching. It is at first diffuse, but usually becomes Grave 
localized on the right side of the abdomen over the symptoms 
region of the appendix. Nausea and vomiting is usual 
and constipation is more common than diarrhoea. 
There is apt to be tenderness over the right side, and 
sometimes a distinct tumor can be made out. The 
temperature is not a safe guide, as it may be found 
normal when other symptoms are grave. The charac- 



172 



HOME NURSING 



Three 

courses 
the inflam- 
mation 
may take 



The ques- 
tion of 
operation 



Cautions 



teristic position of the patient is to lie flat on the back 
with the right leg drawn up. 

The attack may come to an end in one of three 
ways — by resolution, in which ease the symptoms 
gradually subside so that in a week or ten days the 
patient is entirely recovered; by abscess formation 
with increased pain and more extensive tenderness 
over the abdomen, or with a lessening of the pain 
and general symptoms if the abscess has become 
thoroughly walled off; or there may be a rupture of 
the appendix followed by a general peritonitis. 

The question of operation must of course be left 
to the decision of the doctor and surgeon, but in 
general it may be said that unless operation is too 
long delayed it is rarely attended with serious results, 
and that however mild the attack there is always 
danger of alarming conditions developing so rapidly 
that operation comes too late. 

The patient must be kept in bed and on a strictly 
liquid diet. No instructions can be given for treat- 
ment, but it will be remembered that in any inflam- 
matory condition the application of heat must be used 
with caution. 



BRIGHT'S DISEASE 



Causes of 

Bright's 

disease 



Character- 
istic 

changes 
in the 
disease 



Acute Bright's disease or kidney trouble, present- 
ing albumen in the urine, may be brought on by ex- 
posure to cold, as a result of extensive burns, or as 
a sequel of some of the infectious diseases,, especially 
scarlet fever, typhoid, or diphtheria. It may also 
occur during the course of pregnancy. 

The most characteristic changes are indicated by 
the urine, which diminishes in quantity and becomes 
albuminous. There is usually a puffiness about the 
ankles and eyelids, which may spread over the entire 



ACUTE AND NERVOUS DISEASES 173 

body. Headache and gastric disturbances are usual, 
and only the most easily digested foods can be taken. 

It is evident that in any disease of the kidneys 
the waste of the body is not being properly removed, Treatment 
and the defective work of those organs must be sup- normal 
plemented by increasing the activity of the skin. Hot ^"he " 
baths are given and drugs to induce free perspiration Sidneys 
and to increase the amount of urine. The bowels 
should be kept freely open also. Every means must 
be utilized to restore the normal function of the kid- 
neys. 

Increase of the dropsical condition and failure to 

•secrete the normal amount of urine are discouraging Hopeful 

i t 1- • i Slgns 

symptoms, whereas the reverse conditions may be re- 
garded as hopeful signs. 

When giving the hot bath the room should be 
warm and entirely free from draughts, as any ex- Giving 
posure is particularly dangerous. The patient should 
be put at once after the bath between warm blankets 
with abundant covering and hot-water bags at feet 
and sides. A warm drink will also aid in producing 
perspiration. After half an hour the covers may be 
taken off gradually and the patient wiped dry with 
warm towels. 

NEURASTHENIA 

Neurasthenia or nerve- weakness is a condition in- 
dicating lack of power of the nerve centres of the cause of 
body. The common cause for neurasthenia is over- "^nit 
work combined with anxiety. Some persons having 
large expenditure of nervous force have little power 
of creating nervous energy, and wherever the daily 
expenditure of nerve force is greater than the in- 
come of nervous energy the result must plainly and 
inevitably be nerve-weakness or neurasthenia. There 



174 



HOME NURSING 



Symptoms 
of mental 
overwork 



Physical 
symptoms 



Recovering 
from neu- 
rasthenia 



Changing 
the meth- 
od of 
living 



may be a local or a general neurasthenia, the former 
often leading to the latter; hence any nervous dis- 
order, even when confined to a particular part of the 
body, must be regarded as serious because of the possi- 
bility of its resulting in a general nervous break- 
down. 

Some of the symptoms of mental overwork are 
increasing reluctance to take up daily duties, weak- 
ness of memory, insomnia, and a feeling of weight 
or constriction about the head. Sometimes for the 
time being there is an abnormal desire to work, ac- 
companied by vigorous brain activity and an almost 
complete inability to rest or sleep, which heralds a 
serious and sudden collapse of nervous energy. 

There is usually, though not always, great de- 
pression accompanying general neurasthenia, and the 
patient becomes increasingly morbid until his condi- 
tion seems to border on insanity. The feet and hands 
are often clammy and cold and there may be profuse 
perspiration following the least excitement. Short- 
ness of breath and rapid pulse, itching, neuralgia, and 
nervous headaches are symptoms of this disorder. 

Recovery from a condition of neurasthenia is 
always very gradual, and must be gained chiefly 
through rest and proper food. The special method 
of treatment adopted must depend largely upon the 
degree Of the nerve exhaustion. In attempting to rest 
an excited, worn-out brain the effort must be to re- 
move all anxiety and brain-work while still endeavor- 
ing to keep up the interest of the patient and to estab- 
lish the general health of the body more completely. 

To secure this the method of living must be en- 
tirely changed as far as mental atmosphere is con- 
cerned. All brain-work is to be excluded and fresh 
air and exercise in some form is to be added to 



ACUTE AND NERVOUS DISEASES 175 

proper feeding and rest. Quiet travel when properly 
directed affords one of the best means of obtaining 
the desired change in cases where the general 
strength will permit. An ocean voyage which pro- 
vides mental qu>et, fresh air, and an escape from An ocean 
business or domestic activities, or camp lite, which beneficial 
may add the element of exercise in any amount de- 
sirable for the patient, are means which probably 
afford the shortest road to complete recovery. 

To persons of slender means to whom the luxury 
of travel must be denied it should be borne in mind 
that cessation from mental work is an absolute re- 
quirement, whereas such a modification of the method 
of living may be made possible as to take the place 
of the complete change of scenery which is desirable. 
For severe cases the so-called "rest-cure" which has 
been instituted by Dr. S. Weir Mitchell is frequently "The rest- 
most beneficial. The principles of this cure -are "ab- 
solute rest, forced feeding, and passive exercise." 
Complete isolation from friends and relations is 
usually insisted upon, and as far as possible entire rest 
of both body and mind is secured. Extreme care is 
exercised in the feeding of patients, and massage and Need of 
electricity are relied upon to provide the required ^e^ 6 
amount of exercise. The daily routine is so arranged food 
as to take up the patient's time and attention in order 
that the confinement may not seem intolerable. 

Under the guidance of a wise physician and with 
the co-operation of the family and of the patient 
himself, an approach to this method of treatment can 
be made in the home by arranging a daily schedule 
to include stated periods of rest, exercise, and frequent 
regular feedings. 

Wherever there is a derangement of the nervous 
system it should be understood that the nerves them- 



176 



HOME NURSING 



Supplying selves are suffering from a lack of proper nutrition, 
nutrition which we can in part supplement by a judicious over- 
feeding, provided the waste of the body is eliminated 
at the same time. The proportion of fats is always 
increased in the food recommended for nervous pa- 
tients. This need is supplied by a diet of milk, butter, 
cream, and the fats of meat, of which bacon is the 
most digestible. 

At the present time the expense attendant upon 
The reduc- treatment at most sanatoria necessarily shuts out a 
penses in large class of patients, but as the success of the new 
methods gains footing in the popular mind we shall 
have public sanatoria as we have general hospitals 
for the relief of those who can not afford expensive 
treatment. Special rates are already made at some 
of the well-known sanatoria. 



HYSTERIA 



Hysteria 
an actual 
malady 



Those 
most apt 
to suffer 
from 
hysteria 



Very few people other than doctors and nurses 
recognize that the term hysteria stands for an actual 
malady. The person who exhibits hysterical fits or 
who is morbidly emotional and defective in will-power 
is suffering no less truly from a disordered state of 
the nervous system than is the neurasthenic or insane 
person, and the establishment of curative measures is 
equally important in both cases. 

Hysteria is more common among women than 
among men, because of their more excitable and sensi- 
tive nervous system. It develops more often between 
the ages of fifteen and twenty-five years, and the ten- 
dency is greater among young people whose parents 
belong to the nervous type or whose education and 
mode of life tends largely to indoor, luxurious living 
rather than to the more robust out-of-door life. The 



ACUTE AND NERVOUS DISEASES 177 

disease may also follow as a result of overwork, dis- 
sipation, or a long period of severe pain. 

The manifestations of hysteria are very varied. 
The unnatural craving for sympathy which is one of strange 
the characteristics of the disease leads to such warp- JJons of* 
ing of moral purpose that simulation of almost every h y stena 
known disorder is the common practice of hysterical 
patients. It is very difficult for one to realize that 
this deceit results from the fact that the emotional 
nature dominates and that morbid ideas have full 
sway — the dread of a certain disease, for instance, 
being so intense as to cause a patient to feign its 
symptoms. We may regard a person in this condition 
as in some measure irresponsible for her acts because 
of the tremendous power the imagination has over 
conduct. 

Some of the common symptoms to be observed 
are retention of urine or the passage of abundant and Common 

. 1-1 • rin symptoms 

light-colored urine, neuralgia, the sensation of a ball of hysteria 
in the* throat (globus hystericus), paralytic disturb- 
ances, and spasms of one kind or another. Beast 
mimicry, in which the sounds and movements of the 
lower animals are imitated, is observed among children. 
The treatment of hysteria is both preventive and 
curative. The results of inheritance may be largely J f re t ^ e ment 
overcome by careful education of the child, and an difficulty 
effort to secure a normal physical development to- 
gether with a healthy and robust nervous system. 
Self-control must be demanded of the child, and a 
spirit of unselfishness cultivated which may offset in 
a large measure the self-centred interest which is so 
marked a characteristic of the disease. When the 
disease is once established it is often treated like neu- 
rasthenia, with which it is closely allied. Hysterical 
fits need no treatment and the less notice a patient 



178 



HOME NURSING 



Withhold- 
ing sym- 
pathy and 
teaching 
fortitude 



gets on such occasions the quicker will the paroxysm 
subside and the less frequent will they become. 

In general it is safe to say that sympathy must be 
rigidly withheld and all effort directed toward teach- 
ing the patient how to gain a proper self-control. If 
complaints do not reap sympathy they will gradually 
cease. Sometimes the hysterical attacks are made to 
result very disagreeably to the patient and are so 
broken up, as when a physician arrests a paroxysm 
by the injection of a drug which causes vomiting. It 
is possible by some such treatment, if wisely admin- 
istered, to effect a complete cure of the attacks. 



"Reflex 
epilepsy' 



EPILEPSY 

The cause of epilepsy is very little understood. 

The attacks are occasioned by some disturbance of the 

Cause of nerve force occurring irregularly without any apparent 

not known cause, and are attended by loss of consciousness and 

more or less convulsive seizures. 

What is known as "reflex epilepsy" manifests very 
similar symptoms and may follow injury to the head 
in which the skull has become indented, causing pres- 
sure upon the brain. In the latter case a certain 
measure of relief is sometimes gained by means of 
operation, if that is thought advisable after consulta- 
tion. Convulsions resembling epilepsy sometimes ac- 
company affections of the eye and ear, and may cease 
upon the removal of the exciting cause. Also the 
convulsions of hysteria may be confused with true 
epilepsy. 

In typical epilepsy the onset is abrupt and usually 
accompanied by a peculiar sharp cry. The pupils are 
widely dilated, the face livid, and the involuntary pas- 
sage of urine is usual. The duration of the attack is 
seldom more than a few minutes. 



In typical 
epilepsy 



ACUTE AND NERVOUS DISEASES 179 

Hysterical patients rarely do themselves any in- 
jury, whereas an epileptic may injure himself in fall- How the 
big, or bite the tongue badly if not prevented. The attack"* 
movements of hysterical patients are more co- dlffers 
ordinated, the pupils never dilated, and the attack 
is always longer than in true epilepsy. 

Attacks of epilepsy occurring in the night may 
go long unrecognized, but should a person complain 
frequently of soreness of the limbs on waking, head- 
ache, exhaustion, and possibly wetting of the bed, 
such attacks would be suggestive and should be 
watched for. 

Very little can be done for a person who is having 
an epileptic seizure beyond loosening the clothing Car e of 

the epilep- 

and placing a folded towel between the teeth to pre- tic patient 
vent biting of the tongue. This should be done at 
once, as the jaw soon closes tightly and it will then be 
too late to save the tongue from injury. If the person 
is in bed he should be rolled over to one side and the 
mattress protected from the involuntary passage of 
urine which may accompany the attack. 

The younger the age at which epilepsy shows it- 
self the greater the likelihood of serious impairment Variation 
of the mental system, and the more frequent and effects of 
severe the attacks the more speedy is the intellectual e P lle P s y 
ruin liable to be. There are, however, notable excep- 
tions to this general statement, for cases are on record 
of patients who, though suffering from a severe form 
of epilepsy, have for years been able to carry on an 
active life in business without any noticeable mental 
defect. 

As the tendency to epilepsy is transmissible from The epi- 
parent to child, there can be no question as to the moral ™ 
moral right of epileptics to marriage, and it should m ^ ry to 
never be considered. 



180 



HOME NURSING 



INSANITY 



Two forms 
of insanity 



Mania 



Condition 
of mind 



Physical 
condition 
accom- 
panying 
this 



Inducing 
sleep by 
baths 



In the cities where people are so closely crowded 
into homes, the care of the mentally diseased is very 
naturally given over to the institutions specially de- 
signed for them. In the country, however, there is 
more effort made to attempt home treatment, and 
occasionally, with the aid of a good physician and 
untiring nurses, this can be successfully done. 

The two forms of insanity, mania and melancholia, 
demand quite different care. A patient suffering from 
an acute attack of either form may be regarded as a 
hopeful case for complete recovery. 

Mania is sometimes preceded by a period of de- 
pression varying in length of time from a few days 
to a few months before the true condition presents 
itself. 

The final state of mind is one of exaltation and 
the patient becomes so excited by his fantasies and de- 
lusions as to disregard his bodily wants. He becomes 
noisy, incoherent, Often violent, so that it may be 
necessary to resort to mild restraint. A maniacal 
patient seldom commits suicide, but his homicidal 
tendencies are often marked. There is almost com- 
plete insomnia, the bowels are constipated, and the 
skin dry and hot. The appetite seems good, though 
it is usually difficult to make the patient attend enough 
to eat. Bodily activity is absolutely untiring, and the 
care of such patients is most exhausting. 

A certain amount of sleep is sometimes induced 
by means of warm baths, particularly the prolonged 
warm bath at a temperature of no°, which may be 
continued for an hour and a half or two hours if the 
patient is not too restive. Rest in bed is required so 



ACUTE AND NERVOUS DISEASES 181 

far as it is possible to secure it, and massage or 
electricity may be ordered. 

The hair, teeth, and mouth should receive careful 
attention, as in- the case of anv helpless patient. Nour- Careand 

' * nourish- 

ishment is often confined to liquid overfeeding, and it mem 
may be necessary to resort to nasal feeding if the 
patient is unmanageable. 

If the patient becomes very violent and restraint 
is demanded, he should be sent at once to some good Modern 

° methods 

institution where his needs are perfectlv understood in >. nsti - 

r -_ tutions 

and regarded. The period no longer exists when the 
care of the insane in institutions is conducted with 
cruel indifference. Modern methods of treatment 
aim at the recovery of the greatest possible number 
of cases. Restraint is now reserved for the extremely 
violent patients only, and when it becomes necessary 
to resort to it such means are used as will give the 
patient the least possible feeling of restraint. 

As the period of gradual improvement begins, 
every effort is made to divert the patient's mind and 
to give him employment which will interest him. 

In melancholia the condition of the patient is quite 
different. He is seized with persistent and torturing Jhoita dif- 
depression of spirits, is constantly "hearing voices," £™ 1 
which startle him, and are doubtless very real to his man,a 
imagination. The skin is pallid and cold. There is 
continual headache and usually constipation and aver- 
sion to food. 

The feeding of patients suffering from this form Impajr . 
of insanity must be even more carefully regulated 5}|"s5on 
than in cases of mania, as the digestion is often much %£°™~ g 
impaired. The diet should be of nourishing liquids, ™^ ]an - 
eggs, and cereals, with some further variety as the 
physician may allow it. Overfeeding must be very 
cautiously carried out. 



182 



HOME NURSING 



Careful 
guarding 
of the 

melan- 
cholia 
patient 



Do not 

discuss 
delusions 
with the 
patient 



In case 
of forced 
feeding 



Sympathy 
of the 
nurse 
with the 
patient 



Suicide is of frequent occurrence among patients 
suffering from melancholia, and it is never safe to 
leave one unguarded even for a moment, for while 
the back is turned the fatal deed may take place. 
Everything that could possibly be used as a means 
of taking life must be removed from his surround- 
ings. 

In extreme cases the "rest-cure" treatment is ad- 
vised, and in the milder cases it is best that half a day 
should be spent in bed. . 

It is worse than useless to attempt to discuss the 
delusions of a patient with him during the acute stage 
of the disease, and the less attention that is paid to 
them the better for the patient in the end. 

The apathy of such patients is often extreme, and 
forced feeding may become a necessity because of the 
patient's determined desire to starve himself either 
from fear of poisoning or because he may consider 
himself unworthy to eat. The most humane method 
of feeding is through the nose by means of a soft 
rubber catheter, which is inserted through the nostril 
into the gullet for about a foot and a half. The food 
is then poured into the tube by means of a funnel to 
which it is attached. 

A person suffering from melancholia is not in- 
jured by sympathy with his physical or mental 
troubles, as in the case of hysteria, and a wise nurse 
can often gain much through* sympathy, inspiring 
hope, and encouraging effort. 



PART II 
MOTHERHOOD 



THE PHYSIOLOGY AND HYGIENE OF 
PREGNANCY 



Indications of Pregnancy — Quickening — Dress— Need of Fresh Air- 
Exercise —Food— Bathing— Sleep and Rest — Heredity 

THE ordinary woman understands too little of the 
physiology of the organs which come to their full 
development during pregnancy. In discussing the intelligent 
question of motherhood we can hardly expect to take f our 
an intelligent point of view unless we know not only necessary 
the structure and use of these organs, but also their 
relation to other organs and parts of the body. 

The lower part of the abdomen, protected by its 
bony girdle, gets its name from the Greek word mean- 
ing basin. The womb, or uterus, is suspended in this 
cavity, and is kept in its position by ligaments. This ^ pe ° f " 
suspension and control make the organ freely movable the uterus 
and also explain the reason for displacements and 
falling of the womb, which often follows childbirth 
when due care is not taken. 

A full bladder tips the uterus backward, a full 
rectum throws it forward, and when the ligaments why a 
become weakened from any cause it is more difficult rest is 
for it to resume and hold its correct position. This aft^chiki- 
is the case directly after childbirth, and is one of the birth 
reasons why a long rest in bed is such a necessity, 
and why so many women who have not taken the 
proper care are broken down and old before their 
time. 

The uterus itself is somewhat pear-shaped. The Shape of 
larger end points upward and the lower end, which 

(185) 



186 MOTHERHOOD 

is called the neck, extends down into the vagina, 
which is the external opening. 

From the upper angle of the uterus, on either side, 
Function is found a canal called the Fallopian tube, through 
Fallopian which the tiny eggs — the ova — pass on their way to 
ovarie S and the uterus. These germ cells live in the ovaries, 
which are small bodies lying below the Fallopian 
tubes, also on either side of the uterus. The connec- 
tion between the two is through the fringe-like ends 
of the tubes, which grasp the ovaries at the time the 
ova are discharged. 

These then are classed together as the generative 
organs, and their function or use is the development 
of the germ cell, or egg, into life, by its union with 
the corresponding germ cell, or semen, from the male 
parent. 

At puberty the ovaries begin their work of dis- 
Changes at charging ova, once each month, into the cavity of the 
pu er y uterus. These ova, unimpregnated, pass away in the 
menstrual flow. 

The monthly sickness involves no adjustment of 
The ner- the pelvic organs, and no change of their position, as 
tem at pregnancy does, yet we can realize how closely con- 
Sckness nected different parts of our bodies are by the wonder- 
ful mechanism of the nervous system. ' Nearly every 
one is conscious of mental depression or some nervous 
disturbance during the menstrual period, and many 
persons have definite physical accompaniments, like 
headache or enlargement of the glands in the breasts. 
The same thing is true in more marked degree at 
At the the time of the "change of life," when these organs 
menopause are losing their function. The menstruation becomes 
more and more irregular and finally ceases. Some- 
times the flowing is so profuse as to be alarming, at 
such times, and sometimes decreases in quantity. 



THE HYGIENE OF PREGNANCY 187 

The constitutional disturbances are, however, the 
most trying, and as a rule the more vigorous and The con- 
normal a woman has been, the less trying will this disturb- 
period be. The flashes of heat that sweep over the ances 
whole body from time to time are very characteristic, 
and the increase in the size of the abdomen is to be 
expected. If there is any chronic disease it is very 
liable to be exaggerated at this time, and there may 
be pain in the head and back, loss of appetite, or im- 
paired digestion. Depression of spirits is very com- 
monly felt at this time, and an unreasoning apprehen- 
sion about the outcome of this trying period. 

Rest, quiet, nourishing food, and considerate care 
are the chief helps, and before long- the system adjusts Helpful 

1 111 1 t r 1 1 • 1 treatment 

itself to the altered demands. If the disorders are and care 
serious ones the advice of a physician should be 
asked. 

Most of the symptoms manifested in both these 
cases being quite apart from any affection of the Evidences 
pelvic organs must lead us to see how unified our f our 
systems are, and from that to understand the reason systems 
for many of the minor ailments of pregnancy. 

It is, however, the hygiene rather than the ills of 
pregnancy that we are considering. 

We can not, of course, expect perfect physical 
conditions during this state, unless we have a perfect Perfect 

i • i" 1 i i • i • 1 physical 

physical development, which is rare among the women deveiop- 
of this generation, and in this land of little leisure, 
where equal demands are made on the nervous and the 
bodily strength. 

Mr. Dooley says: "Th' difFrence between Chris- 
tvan Scientists an' doctors is that Christyan Scientists 
think they'se no such thing as disease, an' doctors that 
they ain't anny thing else." 

We may run some risk in adopting the Christian 



rnent rare 



188 



MOTHERHOOD 



Child- 
bearing 
is a 
normal 
process 



If a wom- 
an leads 
a normal 
life no 
radical 
change 
necessary - 



The physi- 
ological 
changes 
do not 
interfere 
with or- 
dinary 
duties and 
exercises 



Whole- 
some and 
joyous liv- 
ing adds 
to the * 
child's 
inheritance 



Science point of view in matters of general health, 
but in this question of pregnancy it is certainly the 
saner attitude. This is a matter which we can not 
emphasize too strongly. Child-bearing is a normal 
process. The organs of generation are fulfilling their 
natural use, and the nearer women approach the 
highest ideal of health, the more absolutely normal 
will childbirth become. 

Nature has wonderfully accommodated these or- 
gans and the entire mechanism of the body to this 
function, and only asks to be given fair play. If a 
woman's life is normal, healthful, and wholesome, 
which ought to be one and the same thing, the fact 
that she is to bear a child need bring about no radical 
change. It should not be necessary for her to give 
up her daily occupations or to alter her mode of living. 

The housekeeping cares, even the actual work, and 
the ordinary exercise in the open air, the pleasures and 
duties that commonly form a part of the day, should 
keep their place. Other duties and pleasures will 
come in, to be sure, and the bodily changes during 
the nine months will bring the necessity of adapting 
her life in a measure to the new conditions, but most 
of these bodily or physiological changes are normal, 
and do not indicate disease. 

The more wholesomely and joyously a woman can 
live during this period, the more naturally will the 
changes and the adjustment to them come, and, fur- 
thermore, we must believe, the better inheritance will 
she give her children. 



INDICATIONS OF PREGNANCY 

The first indication of pregnancy is the cessation 
of the monthly flow. The blood which would have 
come away as menstrual discharge is used to supply 



THE HYGIENE OF PREGNANCY 189 

the ovum in it's development. This is not what is Cessation 
called a positive sign, because with some women of the first 
exceedingly nervous temperament an emotional ex- indlcatl0n 
citement, or unusual physical weariness, or slight ill- 
ness temporarily interferes with the regularity of the 
monthly sickness. Interruption may also be caused 
by more serious disease. In rare cases the flow con- 
tinues more or less regularly throughout the entire 
course of pregnancy. But ordinarily its cessation 
may be regarded as an indication that impregnation 
has taken place. 

The glands which are to secrete the milk become 
enlarged, and this growth is accompanied by sensa- Changes 
tions of weight and tingling or pricking in the breasts, milk 
The areola or circle about the nipple gradually be- fhe" breast 
comes darker in color, and later a secondary disk 
appears surrounding the first. Milk can sometimes 
be pressed from the breasts some weeks before de- 
livery, and in the case of a woman who has never 
borne a child this is considered a valuable sign. 

Nausea is a very usual trouble at this time, though 
it is not universal. It occurs generallv on rising or The mom- 

infif sick* 

immediately after the first meal, and may or may not ness 
be accompanied by vomiting. It usually begins about 
the fourth week, and may last two months or longer. 
Occasionally it is so persistent that medical advice 
and treatment are necessary. 

The uterus sinks a little in the pelvic cavity dur- 
ing the early weeks, and draws with it the bladder, Changes in 
which in turn pulls the umbilicus inward. This causes abdomen 
the navel, and in fact the abdomen generally, to ap- 
pear unusually flat. 

By the third month the uterus has risen enough to Gradual 
be felt if the hand is placed on the lower part of the ment^i 
abdomen just above the pubic bone. From this time the uterus 



190 MOTHERHOOD 

on the enlargement increases at the rate of one and 
one-half to two inches every four weeks, until during 
the last month the uterus almost reaches the cartilage 
at the end of the breast-bone. 

At about the middle of pregnancy a physician can 

Beatings determine by the help of the stethoscope the beating 

fetal of the child's heart. This establishes beyond a doubt 

heart the existence of pregnancy, though failure to hear the 

sounds does not negative the diagnosis. The heart of 

the child in the uterus is quite independent of the 

mother's, so the two can never be confused unless 

the frequency of the mother's is increased by disease. 

The fetal heart beats from 130 to 150 times a minute. 

As a rule the larger the child the slower the heart 

action. Boys are usually larger than girls, and so 

False the conclusion has been drawn that the sex can be 

regarding determined by the rapidity of the heart beat. This 

!ngof eat " reasoning is not at all reliable, however, and the same 

heart etal ma y ^e sa *^ °^ most °f tne attempts which are made 

from time to time to determine sex before birth. It 

is quite as well to disregard entirely such methods, 

for they succeed only often enough to convince the 

credulous that they are infallible. 

QUICKENING 

This is the term used to express the activity of the 
The quick- child in the uterus. It was formerly supposed that 
the child until those movements were felt by the mother there 
was no life, but of course conception itself, the union 
of the two germ cells, depends upon the living princi- 
ple within them. 

Quickening is first felt about- the middle of preg- 

its effect nancy. It is often recognized by the mother before 

m P o°ther he tne examiner can detect it, and it may at first give her 

very unpleasant sensations, such as nausea or faint- 



THE HYGIENE OF PREGNANCY 191 

ness. Later in the course of pregnancy the activity is 
often so marked that the examining physician can eas- 
ily see as well as feel them, and the mother sometimes 
suffers pain from the violence of the movements. 

Absence of this sensation does not prove that 
pregnancy does not exist. The child may be dead, 
or it may be quiet during the entire term. If there Signifi- 

11 • • • • r 1 cance of 

has #een activity and it ceases, especially if the absence of 
mother has had an attack of illness, a physician sus- quic emng 
pects the death of the fetus. 

Toward the end of pregnancy, however, the 
growth of the child may, and usually does, prevent 
freedom of movement, so that a woman need feel no 
alarm if she is conscious of little or no quickening 
during the last two months — unless there has been 
sickness of severity enough to warrant the death of 
the child in the uterus. 

There are diseases which present symptoms so 
nearly like those of pregnancy that even physicians 
are sometimes misled. In intenselv nervous or hys- False , 

J . J signs of 

terical women many of the signs are so closely simu- pregnancy 
lated that they deceive every one. The cessation of 
the menses, the sympathetic stomach disturbance, and 
even the abdominal enlargement are present. 

If suspicion arises in the mind of the physician, 
he will probably administer ether, and make an ex- 
amination while the patient is under its influence. Examina- 

tion by 

The muscles are then relaxed, and the true condition physician 
can be ascertained. There may be a distention of the 
uterus or of the abdominal cavity, from gas or fluid, 
in which case most of the reliable attendant signs 
are lacking. 

After long experiences, such as a woman gains Shape of 
by repeated pregnancies, the shape of the abdo- me/char- 
men is a very significant sign, and its characteris- 



actenstic 



192 MOTHERHOOD 

. tics are such that there is generally little difficulty 
in diagnosis. 

The outlines of the pregnant uterus are very 
smooth, and its shape is even. There is a peculiar 
elongation in the enlargement of the abdomen, and 
on pressure it seems very stiff and elastic. Generally 
the uterus can be felt to contract, especially if a cold 
hand is laid over it. 

It is hardly too much to say that in doubtful cases 

even a very clever physician can rarely make an un- 

Positive qualified statement about the existence of pregnancy 

aSTsTn's before the middle of the period. Then rarely is there 

not mani- hesitation, because the probability of pregnancy as 

fest the , , r i . • r ,1,1 

first the result of the marriage union of a normal, healthy 

man and woman is so great, but mistakes in diagnosis 
are so severely criticised that it seems only fair to call 
attention to the fact that the positive, unmistakable 
signs are not manifest during the first weeks. 

DRESS 

For the first two months in a normal pregnancy, 
few changes need be made. After this, the clothing 
will begin to feel tight, and it must be loosened. Cor- 
sets should be discarded, in order to remove pressure, 
both from the breasts and the uterus, which is steadily 
must*!* mounting in the abdominal cavity. The corset waist 
anTskirts ma y ^ e substituted to give the accustomed warmth, 
hung and to serve as a support for the skirts, which should 

shoulders be fastened to it, or suspended from the shoulders. 
Princess gowns, or those made with jackets, having 
full vests, are very practicable, as they emphasize the 
size of the figure less, besides being more comfortable 
than the ordinary costume. 

Now, more than ever, one should be protected from 
the cold, and yet the clothing should be light in weight. 



THE HYGIENE OF PREGNANCY 193 

High shoes should be worn, to give extra support to 
the ankles, and the stockings should be held up by Warm, 
straps at the side, never by round elastics, which, if i 00 se 
effective, constrict the legs, and interfere with the clothing 
circulation, often causing varicose veins. 

NEED OF FRESH AIR 

The essential fact to bear in mind is that the body 
is doinsr work for two instead of one. As the blood The mo f n - 

° ... ers body 

flows through the arteries, carrying nourishment to doing 
the various parts, it loses its life-giving properties, and breathing 
it must take its way back through the veins to the for two 
lungs, to be re-vitalized by the pure air. This work 
of the circulation in taking oxygen to the tissues is as 
important a part of respiration as the familiar act 
whereby the lungs alternately inhale air and expel it. 

For the little new life, which has its being through 
the parent, this internal respiration constitutes the imperative 

. . < . • , , "eed of 

entire process, for it has no communication with the fresh air 
outside world. This means that the rooms should be 
well ventilated, so that with each breath the lungs may 
be filled with fresh air. 

Inside chambers, having no windows opening out- 
of-doors, are never suitable for sleeping rooms, and f t ^ y of 
now when every atom of vital power needs to be vital 
saved and used they are especially to be condemned, needs to 
Remember that a fire, gas or a lamp will use up oxy- e save 
gen, so that more ventilation is needed when they are 
burning. 

EXERCISE 

The exercise in the open is equally important if it 

serves only to fill the lungs a few times with fresh air. 

Walking is a safe exercise, and may be followed up 

during the entire term. Driving, unless it must be 

9 Vol. 3 



194 



MOTHERHOOD 



over very rough roads, is equally beneficial. It must 

Howmus- be remembered that absolute rest is not a wise general 

erc^ehls prescription for the pregnant woman. She needs oc- 

vaiue cupation to keep her healthy minded and happy, and 

labor is usually less painful when the muscles have 

been kept in good working order. 

Sometimes trifling discomfort, particularly in a 

young woman, makes h'er fail to realize this, and she 

■is inclined to lie down when physically she is quite 

able to take moderate exercise. The open air, with 

The open its change of scene and diversion of the mind, is her 

air a ° • 

safeguard safeguard, for if she makes an invalid of herself, and 
keeps her mind full of unpleasant possibilities, the in- 
validism will tend to become a fact, and the nervous 
apprehension will result in hysteria. 



FOOD 



Nourish- 
ing and 
sufficient 
food to 
meet the 
strain 
upon the 
body 



What 
proper 
food is 
at this 
time 



The same fact— that double duty is being laid upon 
the system — must also be borne in mind when we take 
up the question of diet. If the ordinary food served in 
the family is carefully chosen, for its nutritive value, 
and properly prepared, there is no reason why any 
deviation from it should be made. The tissues are 
under tremendous strain with repairs of the old and 
construction of the new. Since our food is the source 
of our bodily heat and energy, and since by means of 
it our bodies are built up and maintained in health, we 
can see that the stomach must now be given proper and 
sufficient material for its work. 

Proper material means wholesome, digestible food. 
It does not mean an excessive amount of stimulant 
like coffee or tea, which gives an artificial vigor, and 
lessens the desire for food. Neither does it stand for 
a specified diet of any one kind. The system needs now 



in 

excess 



THE HYGIENE OF PREGNANCY 195 

more than ever the variety in food that will bring to 
each part the nourishment it especially requires. 

The claim that the use of a strictly vegetable diet 
will assure an easy labor is only a theoretical supposi- The fan 
tion, based on the idea that the bones of the child about a ' 
would then be less well developed. If this were true, J^ etable 
it would seem a more far-seeing plan to choose food 
which would keep the mother robust and able to endure * 
the extra pain of bringing into the world a well-nour- 
ished, sturdy child. 

Rich, fatty foods, fried dishes and pastry or sweets 
in excess are to be avoided, not only during pregnancy. Avoid 
but at all times. We all recognize that these things are dishes, 
bad for children, and in the majority of households, sweets' 
where the children eat with their parents, it is well 
nigh impossible to restrict their fare. The simpler 
method is to choose healthful, digestible food, and to 
exclude altogether the forbidden fruits. 

During the course of pregnancy, there are frequent- 
ly abnormal longings for some one kind of food. It is c i rati r fyil J g 
often perfectly possible and legitimate to indulge this jong- 

o « ings of 

appetite. Sometimes it may mean that the system appetite 
needs the acid of certain fruit, or other material which 
the desired food contains. It will be found, however, 
that gratification is not always essential, and it is not 
wise to let the longing hold too important a place, for 
the more constantly it is kept before the mind, the 
more fixed it becomes. When the appetite is diseased 
and demands such things as slate pencils, chalk, or 
starch, the physician can generally correct it with 
drugs. 

It seems to be necessary at all times, in season and 
out of season, to urge the free use of water. This fi ts from 
applies in health and in disease, to the pregnant woman ^water 
no more than to every one. Water is cleansing inside 



196 MOTHERHOOD 

as well as outside. It helps sweep away the waste 
matter which is disposed of by the kidneys. It reg- 
ulates the body-heat by its effect on the sweat glands, 
and it is a great aid in correcting constipation, one of 
the special ills of pregnancy. 

BATHING 
The reasons for frequent bathing have already been 
Repetition given in the chapters on Home Nursing, but I should 
of rea- jj^ e to rev i ew them here. We are constantly shedding 

sons for J & 

bathing tiny scales of scarf-skin. The sweat glands are also 
continually pouring out their fluid, the perspiration, 
in greater or less abundance, and the oil glands are all 
the time adding their secretion. 

These pores serve an important purpose in keeping 

stoppage our bodies in a state of health. If this mixture of oil, 

pores ie f perspiration, and scales of skin is allowed to accumu- 

the skm j ate t j ie mou th s f the pores will be more or less 

stopped and their work will be interrupted. 

The oil-glands keep the skin smooth and flexible. 
in h< winter S Through the sweat glands the heat of the body is reg- 
and in ulated. In winter, when extra heat is needed in the 

summer , . 

body to resist the cold, the openings of these pores are 
narrowed, and very little perspiration is secreted. In 
warm weather, on the contrary, perspiration is poured 
out in quantities, and the heat of the body is reduced. 
This statement in itself proves the importance of 
giving these glands free play, which cleanliness cer- 
tainly will do. 

. The tepid bath is the safest for the pregnant wom- 

The tepid an. The cold plunge or shower is liable to prove too 

safest great a shock to a system which is carrying a double 

load, and the healthful reaction is less likely to follow. 

A hot bath may have a tendency to stimulate the uterus 

before it is time and may bring on miscarriage. 



THE HYGIENE OF PREGNANCY 197 



SLEEP AND REST 

If the simple, healthful life is an accomplished fact, 
and not a pleasant theory, the question of sleep will 
generally take care of itself. The exercise in the open 
air gives one the desire for sleep ; the bath, if taken at 
night, quiets the nerves and relaxes the muscles, and 
insomnia is rarely a serious difficulty.. Various de- 
vices to induce sleep are found in a preceding chapter. 

The importance of rest is not at all appreciated by 
the American woman. She regards Nature as an im- Th e impor. 

. tance of 

pertinent mentor if Nature ventures to step in and rest to the 
make demands in return for the many burdens that mother 11 
are laid upon her. 

Our bodies always have a right to consideration, 
but never more than when the well-being of another 
life is dependent upon them. Physical and mental 
health are all-important to the expectant mother, and 
she should take her rest as conscientiously as she does 
her work. 

Even if sleep during the day is impossible, relaxa- 
tion with the clothing loosened will refresh her and J he <i uiet 
should have its plan in the routine of each day. The 
nights will be more restful if the days are not over- 
crowded, and an hour in a quiet room, with the mus- 
cles resting, and the mind unoccupied as far as may 
be, will do much toward keeping the nine months a 
normal period. 

We are too much afraid of resting. We feel that 
the lagging nerves must be spurred on, and that it 
is weak yielding if we obey their warning, and stop 
when they call. Consequently we do apply arti- 
ficial stimulants in the way of excitement and the Falsity of 
strength of our wills, and we do not feel conscious of stimuia- 
failing nerve power until after the strain is off. Then tlon 



198 



MOTHERHOOD 



A rule 
of living 
for the 
pregnant 
woman 



"The gos- 
pel of re- 
laxation" 



we awake to the fact that our reserve is gone, and we 
find ourselves much less useful members of society, and 
much less happy women than we might have been. 

The pregnant woman should keep early hours, oc- 
cupy a bed by herself and sleep eight or nine hours 
out of the twenty-four. 

There is "power through repose," and relaxation is 
a safeguard that not only brings more complete rest 
in our unoccupied moments, but will lessen pain or dis- 
comfort to a remarkable degree. Pain gains its hold 
through our tense rigid muscles and nerves. The non- 
resistant is a "more elusive foe than the aggressive, and 
in health or disease, under normal or abnormal con- 
ditions, the "gospel of relaxation" is the gospel of 
healthful living. 



About 

ante-natal 

influences 



Birth- 
marks 



HEREDITY 

The question comes up in the mind of every expec- 
tant mother as to how much she can influence the phys- 
ical and moral well-being of her child before birth. 
Sentimentalists tell her that she can impress the grow- 
ing life within her through the influence of her own 
mind ; that she can "mark" the child with beauty, with 
love for music, with a cheerful or a despondent dis- 
position ; that she can give him a bent toward a given 
end by turning her energies in that direction during his 
fetal life. 

As a matter of fact, the deformities and birthmarks 
that sometimes disfigure a baby result from some ex- 
citing circumstance which took place before the child 
was fully formed in the uterus. After this, the de- 
velopment of the child has proceeded so far that 
no external event except actual violence can affect 
the physical make-up. 

The mechanism of the nervous system is more com- 



THE HYGIENE OF PREGNANCY 199 

plex and more delicate, but it seems hardly possible 
that mental processes of the mother should be able to 
react at all on the nerve centres of the child. 

The essential fact is that her general well-being does The moth- 
tell directly on the child through its influence on the era* weii- 
quality of the blood supply upon which his develop- Jj""^ J£ e ls 
ment depends. child 

This is true before birth, when his life is literally a 
part of hers, but is almost as important a fact, when the I1Is ? nd 
fact that she furnishes his food supply is their only affect the 
vital connection. Even then we find the nervous and ^Sk Y to° 
physical condition of the mother reflecting directly the chlld 
upon him, as her bodily ills or emotional excitement 
affect the secretion of milk. 

All this goes to show that she can help in giving Thus she 
him the inheritance of a healthy body which will in- }. e]ps \° . 

J J the inhen- 

crease his chances for full normal mental development, tance of 
and it is to this end that she may best devote her en- body 
ergies. 

Biologists have investigated, discussed, and dis- 
agreed upon the subject of heredity, and many the- 
ories that were held true in years gone by are now 
believed to be without foundation. 

In spite of the differences of opinion on many tech- 
nical points the general supposition at the present time Direct 

- , . r . , . , , . transmis- 

on the subject of inheritance seems to be that there is sion of 
in most cases no direct transmission of disease. This f r0 m Se 
means that the child of a consumptive parent, for in-3S5nJe 
stance, is not necessarily born a consumptive. It does 
not mean, however, that he is no more liable to develop 
tuberculosis. Disease is not transmitted, but the weak- 
ness of a part, with a tendency to become diseased, 
may be. 

Heredity, then, is a question of inherited tendencies, 
rather than of definite characteristics, and may be over- 



200 



MOTHERHOOD 



Heredity 
is inher- 
ited ten- 
dencies 



The birth- 
right of 
every 
American 
child 



balanced by hygienic surroundings and wholesome 
living. This puts more responsibility rather than less 
upon the shoulders of the parent, both as regards 
bringing children into the world with the handicap 
of inherited weakness and as to their care after birth. 
If the first responsibility is assumed, the second 
should not be shirked. Especial advantages in the way 
of proper exercise in pure air, good food, and watch- 
ful care are demanded, and no effort should be spared 
to give to a child its proper birthright — the chance of 
development into normal, healthy, efficient manhood 
or womanhood. 



II 

AILMENTS OF PREGNANCY 

Nausea— Constipation— Increased Salivation — Varicose Veins and Hemor- 
rhoids — Decay of Teeth — Palpitation — Sciatica — Pruritus — Irritation of 
Bladder— Abdominal Bandage— The Physician— Midwives— Advice of 
Friends— Receipts for Special Diet 

I HAVE asked you to take the attitude of regarding 
pregnancy as a normal state, indicating the devel- 
opment of organs and the fulfilment of the purpose for 
which they were largely made.* Now in seeming con- 
tradiction to this, I suggest in the heading of the chap- 
ter that there are ills which we must consider. 

If all women had always lived in accordance with hadMived 
Nature's laws, if they had never w r orn clothing that ^ n it £ c< g^ d 
changed the shape of their bodies, if their food had al- ture ' s laws 
ways been wholesome, so that the digestion was un- 
impaired, and if they had plenty of vigorous out-of- 
door exercise, so that all the muscles were supple and 
well developed, probably child-bearing would be an in- 
cident rather than an end in their lives, and children 
would be given a fairer start and less of a handicap in 
inherited weakness. 

Since, however, it is not perfectly normal woman- 
hood which we have to consider, we shall find certain 
ailments which are almost universal accompaniments of 
pregnancy. These ills, the nausea, the discomfort of 
increasing size, and the intestinal difficulties, seem 

* Scientists now believe that the ovaries play an important part 
in the organism, in helping to establish and maintain vital force, 
quite aside from their function of reproduction. 

(201) 



202 



MOTHERHOOD 



Uterine 
growth 
during 
pregnancy 



Ailments 
this 
growth 
induces 



Freeing 
the mind 
from un- 
necessary 
alarm 



sometimes like unnecessary burdens, till we realize 
what a wholesale adjustment to new conditions there 
is throughout our bodies, and see how wonderfully 
Nature has planned. 

The normal size of the uterus is three inches long 
by one and a half wide. Its weight is about one ounce. 
In nine months these dimensions change to twelve' 
inches in length by nine inches wide, and the weight 
to two pounds, not including the contents. This in- 
crease means growth, we must remember, not a mere 
stretching of elastic tissue, so that the contents of the 
uterus may be accommodated, as is shown by the fact 
that the walls are thicker, rather than thinner, toward 
the end of pregnancy. 

As the position of this organ changes, the other 
organs in the abdomen must adjust themselves. The 
uterus presses backward against the rectum, and con- 
stipation results ; it pushes forward against the blad- 
der, and there are difficulties in the retention or the 
passing of the urine ; as it rises in the abdominal cavity, 
the stomach is affected and we have the nausea of 
"morning sickness," while later the heart is forced to 
accommodate itself to the new conditions, and retal- 
iates by palpitation. 

This is the rational point of view, and if the woman 
who is to become a mother keeps these physiological 
changes in mind, she will understand better many of 
the ills attendant on pregnancy, and will be saved un- 
necessary alarm. We can very well balance up our 
physical ills in two columns of cause and effect, and 
this period is no exception to the general rule. 

We have already remarked that nausea, constipa- 
tion, irritation of the bladder and palpitation follow in 
natural sequence the increasing size of the uterus. 



AILMENTS OF PREGNANCY 203 



NAUSEA 

The nausea usually passes away in a short time. 
If it persists, various experiments in diet must be tried, if nausea 
Often liquid food and rest in bed will entirely correct 
the trouble. It is usually the early meal which the 
stomach refuses to retain, and sometimes if this meal 
is prepared and served in an unusual way it will be 
digested. 

Prepare it entirely out of the sight of the patient, 
and serve' it very early in the morning, before it is fh^rfak- 
time for her to get up. After she has eaten it, imme- fast vef y 

° . early 

diately darken the room, and leave her to sleep again. 
If extreme care in diet fails to overcome the nausea, 
it may be worth the attempt to give the patient the 
first solid food she craves. Sometimes a diet that 
seems entirely unsuitable may check nausea, which ap- 
pears almost to have become a habit. Ices and ice- 
cream may be given, and the latter, especially if made ices and 
with a custard, furnishes considerable nourishment, devices 
Pop-corn sometimes can be retained and will help cor- 
rect the trouble. A mustard plaster over the stomach, 
an ice-bag at the back of the head, or bits of ice taken 
by the mouth, are other devices that may be tried. 

An entire change of surroundings will often effect 
a sudden and complete cure, and it is advisable if the Break in 
nausea does not readily yield to the ordinary treatment t0 med life 
to go away from home' and one's immediate family, 
to make an absolute break in the accustomed life. 

As the stomach becomes used to the increased pres- 
sure, and to the extra demands made on its blood sup- 
ply, it generally resumes its normal function. If, how- 
ever, none of these devices is successful, and the 
strength seems to be failing, the patient can be nour- 
ished for weeks by nutrient enemata. 



204 



MOTHERHOOD 



CONSTIPATION 



of consti 
pation by 
diet 



Constipation is liable to be manifest throughout the 
Correction nine months. Much can be done to correct it by means 
of diet and exercise, and this method should be used 
before drugs are resorted to. Fruits, cereals, coarse 
bread, like graham or rye, help the action of the 
bowels, because of the amount of fibre, which, not being 
acted upon by the digestive juices, serves as a slight 
irritant to the intestinal wall. 

If one will stop to consider, one can easily find a 
varied dietary which tends to relieve constipation. All 
the cereals (except rice), graham, rye, corn, and brown 
bread, fresh meats and fish, vegetables and fruits of 
all kinds, certainly offer a choice of which one need 
not tire, while toast, cooked milk, soda crackers, tea, 
and spirituous liquors, sweets, nuts, cheese, and rice 
are distinctly constipating and should be avoided. 

Add to all this, and above all this, the free use of 
drinking water. If water is distasteful, the increase 
of salt in the food will give a desire for it. It should 
be added that hard water is extremely constipating. 
Boiling it will remove in part at least the substances 
which make it hard, and this should always be done if 
soft water is not available. It may be brought to boil, 
cooled, then put in bottles and chilled. Long boiling 
gives it a disagreeable taste. 

Exercise helps in all normal functions, and a gentle 
circular rubbing of the abdomen, with an increase of 
pressure over the left side, sometimes stimulates in- 
testinal activity. 

If the trouble is obstinate and persistent, drugs or 
injections should be used, for it is of the utmost im- 
portance that the system be kept in order and the 
wastes of the body be removed. 



What to 
avoid 



Free 

drinking 
of water 



Exercise 



AILMENTS OF PREGNANCY 205 



INCREASED SALIVATION 

A patient is sometimes troubled with an excessive 
secretion of saliva, which may continue for a few 
weeks, but which sometimes persists throughout preg- 
nancy. It is not a dangerous ailment, but may be a sugges- 
troublesome one, especially when the glands become ^°" e s f f j° r 
tender and the gums are swollen and recede from the mouth 
teeth. Astringent mouth washes, such as hamamelis and laxa- 
or tannin, generally relieve somewhat, and if the se- 
cretion of the intestinal tract is increased by saline 
laxatives (Rochelle or Epsom salts) the excessive sali- 
vation may be checked. 

VARICOSE VEINS AND HEMORRHOIDS, OR PILES 

Both these conditions are caused by undue pres- 
sure upon the large veins, causing dilation of the 
branches below them. 

In the condition known as varicose veins those 
vessels in the legs become much swollen, as the word 

. ,. , 1 • 1 Varicose 

varicose indicates, and their course becomes tortuous, veins and 
This trouble is in itself very painful, and may lead 
to a serious difficulty if not remedied. This difficulty 
is rupture of the vein and consequent hemorrhage. 

To guard against this possibility a bandage or 
elastic stocking should be constantly worn if the veins 
appear prominent. The bandage may be of flannel, thTieg" 1 * 
cut on the bias, and should be evenly and closely ap- 
plied, beginning at the ankle. 

Very gentle rubbing, always away from the ex- 
tremities, and toward the heart, sometimes relieves 
the pain or feeling of pressure, and if the skin feels of h rubbin ef 
dry, or as if tightly stretched, oil may be used for 
this rubbing. This is equally useful treatment for the 
abdomen as the tension becomes great. 



massage 
is not 
effective 



206 MOTHERHOOD 

It is a very good plan to give the breasts also a 

Prepara- little preparatory treatment, consisting either of alco- 

ment of hoi bathing, which toughens the skin and makes it 

the breasts | egs sens jti ve when the nursing begins, or of a gentle 

rubbing with oil, always toward the nipple, which 

should be pulled out with the fingers if it is not 

prominent. A baby will often' refuse to nurse if the 

breasts have very small or sunken nipples, and this 

treatment carried on for a few weeks before delivery 

will put the breasts in good condition, make the skin 

more flexible and less liable to chap, and will save 

much discomfort. 

It is often the pressure of tight corsets which has 
Methods made the nipple flat, and if the massage treatment is 
e not effective it can be drawn out with a breast pump 
or similar apparatus. Take a large-mouthed bottle, 
fill it with boiling water, then empty it and quickly 
invert over the nipple. As the air in the bottle cools 
a partial vacuum will be formed, and will cause the 
nipple to be drawn out Another still more simple 
method is to place the bowl of an ordinary clay pipe 
over the nipple and, with the stem between the lips, 
draw out the air. Very little effort exhausts the air 
and pulls the nipple well out. 

If this practice is regularly observed, the nipples 
Valuable can t> e brought into' much better condition before the 
results to baby is born, and the amount of worrv and work that 

baby and •* 

mother is saved is not appreciated until one has suffered the 
annoyance of having a hungry baby entirely unable 
to take the breast. 

Hemorrhoids or piles are caused also by the con- 

The cause gested condition of the veins. Those vessels in and 

rhoids" 10 about the rectum become swollen, and small tumors 

appear, which may protrude on the outside or may be 

entirely internal. Constipation is often the cause, 



AILMENTS OF PREGNANCY 207 

though sometimes the trouble is present when the 
bowels are in normal condition. 

Rest in bed generally corrects the congestion. It 
may, however, be persistent, when it is intensely pain- Methods 
ful, and is often accompanied by a nervousness which relief 1 " 1 
can not fail to react on the entire system. Com- 
presses wet in witch-hazel, diluted one-third with 
water, either cold or warm, give relief, and if the 
hemorrhoids are internal an injection of about a tea- 
cup of this witch-hazel solution retained in the bowel 
is often helpful. An ointment made of witch-hazel 
tends to contract these small tumors and thus to re- 
lieve the pressure on the nerves. 

Diarrhoea and constipation have an equally bad 
effect upon the condition of pregnancy, and an especial 
effort should be made to keep the bowels well regu- 
lated. 

DECAY OF TEETH 

That this trouble should accompany childbirth is 
not surprising when one considers what demands are 
made upon the vitality of the mother. 

It seems to be universally true that dental difncul- Demand 
ties follow the pregnant state, and often the nervous sy S °tem he 
condition of the woman is such that repairing - treat- l f a £ s , t0 . 

r ° difficulties 

ment is impossible. Such temporary work as can be with the 
done is, of course, advisable, to save pain, and to pre- 
serve the teeth. 

Otherwise Friar's Balsam, Compound Tincture 
of Benzoin, often gives relief. Iodine may help, and Reliefs 
in cases of neuralgia hot dry applications are sooth- 
ing. It may also be comforting to remember that 
these difficulties, like the unpleasant moth patches or 
pigmentation of the skin, pass away with the birth of 
the child. 



208 MOTHERHOOD 



PALPITATION 

This is more often present during the later months, 

th*e USe ai° f w ^ en tne uterus has risen so high in the abdominal 

pitation cavity that by its pressure it interferes with the action 

of the heart. Very little can be done to relieve this 

condition, but it is usually of short duration. 

Coughing and labored breathing during pregnancy 
Cough- a i so n eed occasion . no alarm. In the early months 

ing and * 

labored they are doubtless nervous or sympathetic troubles, 
ing and later they are due to the pressure of the enlarged 
uterus. 

SCIATICA 

Pain in the sciatic vein which runs down the 
Causes of under side of the leg from the thigh is sometimes 
caused by pressure due to constipation or to a dis- 
placement of the uterus. If brought about by the 
former, laxatives and thorough rectal irrigations con- 
taining oil or glycerine, to empty the bowel com- 
pletely, is the treatment suggested. Constipation 
should be especially guarded against. 

PRURITUS 

A general itching of the skin, with no sign of erup- 
The cause tion, is a nervous disorder which is very trying, and 

of the ' . , T . J ° , 

itching may be a great strain on the system. It is aggravated 
relief 3 a ^ the periods when the menses would ordinarily 
occur. Baths in water containing baking soda relieve 
the itching, particularly if followed by a thorough 
rubbing with vaseline. Bismuth, zinc oxide, or starch 
may be used to powder the skin, and linseed oil or 
lime-water may be applied on a cloth. It is a condi- 
tion which is difficult to cure, but which usually ends 
with the birth of the child. 



AILMENTS OF PREGNANCY 209 

IRRITATION OF THE BLADDER 
Irritation of the bladder is usually caused by pres- 
sure of the enlarging womb during the first months Remedial 
of pregnancy. Mucilaginous drinks, such as flax- 
seed tea or slippery elm, will sometimes relieve the 
pain, and keeping the bowels open assists by freeing 
the bladder from additional pressure. 

ABDOMINAL BANDAGE 

Sometimes the abdomen is so large that moving 
about is difficult, and there may be considerable pain 
felt on walking. A fitted bandage can be used in such 



The use 



Abdominal Bandage 

cases, and may give great relief. Regular abdominal 
bandages can be purchased at shops where surgical of ,c a b U 
or hospital supplies are kept, but they are very ex- j^ 1 " 3 * 
pensive, and it is possible to cut and fit them at home, 
using one of the paper patterns. Unbleached muslin, 
lasting, or twilled cotton are suitable materials, and 
the bandage should be closely fitted so that it will 
actually support the dependent abdomen. 

These, then, are some of the minor ills that may 
complicate the state of child-bearing. They may be 
extremely uncomfortable and they may restrict one's 



210 MOTHERHOOD 

method of living, and clamor till they draw attention 
to themselves, and divert one from the desired state 
Minor ills of healthy-mindedness. But after all these ailments 
nancy Cg are temporary, none of them lasting beyond the nine 
and P not ry montns > and most of them merely incidental during 
alarming that time. None of them need occasion alarm, if 

if ordi- . . 

nary care ordinary care is taken, as in the case of the varicose 
veins to bandage the legs, or in constipation to cor- 
rect the difficulty and keep the system in order. 

THE PHYSICIAN 

There are symptoms, however, which need to be 

when the regarded, which if noticed in time and reported to a 

mother" good physician may be relieved, but which may result 

choose her * n alarming disease if allowed to run their course. It 

physician [ s on this account that I should advise the young 

mother to choose her physician and put herself under 

his care during the first months of her pregnancy. 

Certain symptoms, such as persistent headache, 

Symptoms spots before the eyes, scanty, high-colored urine, a 

for special x J J ° 

treatment dropsical, appearance, or flowing before term, should 
always be reported as soon as they are noticed, be- 
cause they may be indications for special treatment. 
The urine is a valuable guide to the physician in 
The urine diagnosis, and frequent examinations of it are ad- 
as a guide yjg^j^ Three pints in the twenty-four hours is the 
normal amount, and often if the quantity diminishes 
it is only because the patient is not taking enough 
fluid, and it can be brought up by increasing the daily 
supply of water. 

It is perfectly feasible for a woman to have a 
its prepa- little oversight in regard to the quantity passed, and 
ration for j ts appearance, and if she finds either out of the nor- 

examina- x x ' 

tion mal she should at once send a specimen to her phy- 

sician for examination. A pint graduate-glass can be 



AILMENTS OF PREGNANCY 211 

used for a measure, and the amounts recorded, or a 
large bottle or jar can be substituted. The pint or 
half-pint measure can be indicated on the bottle by 
strips of cloth, paper, or adhesive plaster pasted on. 
The receptacle for the urine should be washed and 
scalded each day. In sending a specimen to the Sanitary 
doctor special care should be taken to wash the bottle necessary 
and the cork very thoroughly, as impurities added in 
this way may interfere with the result of his examina- 
tion. A physician is then capable of judging whether 
the condition is a serious one, and he can relieve the 
minds of his patient and of her friends, besides giving 
the essential remedies. 

• MiDWIVES 

I have spoken of engaging a physician, and have 
not considered any alternative. There ought to be 
none, and yet midwives do a flourishing business, in The dan- 
spite of the increase of knowledge upon the subject f;tt7 e US 
of proper care in confinement. If we could trace Jj °^ dge 
back the histories of the cases of blood-poisoning fol* wives 
lowing childbirth that are brought to our hospitals — 
which, in fact, has been done — we should find a sur- 
prising proportion of them laid at the door of the 
midwife. A little knowledge is a dangerous thing in 
the practice of medicine no less than in philosophy, 
and this is where the danger lies. 

Childbirth is so nearly a normal process that 
many women pass through the ordeal safely with 
assistance only in regard to separating the child from 
the after-birth. The trained and licensed midwives 
do understand fairlv well the after-care of mother and And their 

' 1 -1 i i e' • consequent 

child, but most of them are entirely unequal to any inability 
emergencies, and so suspicious of any lack of confi- emergcn- 
dence in their ability that they often will not confess cies 



212 MOTHERHOOD 

lack of knowledge till the trouble has become com- 
plicated. 

Any medical student who has served his term in 
Principles a hospital understands the principles of absolute sur- 
cai^iean- gical cleanliness and the importance of carrying them 
regarded" ou * * n c o n fi nemen t cases. But with many midwives 
these principles are unappreciated or disregarded, and 
while they may be clear-headed, capable, and vigor- 
ous in normal cases, their lack of technical knowledge 
makes their presence in the lying-in chamber a men- 
ace rather than a safeguard. This is probably truer 
of the older women of this class than of the younger 
ones, who have much more thorough training, but it 
is impossible that they should have the technical skill 
of the reliable physician. 

ADVICE OF FRIENDS 

If it is wise to consult a physician it is equally ad- 
Do not visable not to consult one's friends and neighbors. 

consult ■ . 7^ 

friends or So many well-meaning and kindly women have a 
neig ors mor ^^ j ove f or ^ abnormal that they treasure all 
the grewsome tales they have heard and retell them — 
in even more grewsome detail — for the benefit of the 
young expectant mother, who may be puzzled by per- 
fectly natural symptoms. 

I was called the other day to see a small boy who 
A touch- had pneumonia. The mother met me at the door, in 
mg story tears ^ anc j as j wen t into the room she said sadly, "I 
am afraid Donald is leaving me." One or two neigh- 
bors were standing about in the little room, looking 
their sympathy. . 

I went to the bed where the child was lying. His 
pulse was full, regular, and not as fast as the day 
before, and the little hand I held in mine was moist 
and cool. His eyes were closed, not half-opened as 



AILMENTS OF PREGNANCY 213 

sick children's often are, and his breathing was deep it was 
and easy. It was returning health, not death, that heaith, ing 
had quieted his delirium and had put him to sleep. not death 

His mother told me afterward that she had not 
been so alarmed when he became quieter till a friend 
had come in and, on looking at him, had shaken her 
head and said, "This is the end," and had gone out 
without more words. It was absolutely unnecessary 
alarm, and, even if his condition had been serious, 
nothing would have been gained. The mother, who 
needed all her strength and alertness, was undone 
and helpless. 

This is somewhat far afield from our subject, ex- 
cept to show that the judgment of the untrained 
person may better be withheld, especially when it 
finds no helpful expression. 

Cheer and hopefulness take us out of many a 
slough of despond, and the prospective mother, par- 
ticularly at the birth of the first child, should have a hopefulness 
double portion. It is a strange road that she treads, prospective 
and there are dark places where she needs the mother 
friendly hand and reassuring word to give her 
courage. 

SPECIAL RECEIPTS— IN NAUSEA 

This is one of the most digestible forms of milk, Koumiss 
and can often be retained by a very delicate stomach 
when other foods cause nausea. 

Dissolve one-third of a yeastcake in lukewarm 
water. Stir the water into one quart of milk of the 
same temperature. Add one tablespoon of sugar 
and fill bottles within one and one-half inches from 
the top. Cork and invert the bottles, and let them 
stand at a temperature of 8o° F. for six hours. The 
corks should be tied securely unless bottles with 



214 MOTHERHOOD 

patent stoppers are used. Chill and serve on the 
following day. 

If the digestion is impaired it may be well to give 
Peptonized partially predigested milk, which will relieve the 
stomach of a part of its work. 

It must be understood that the digestive ferment 
used in such a preparation continues its action as 
long as it is kept at a favorable temperature. Con- 
sequently the milk must be taken very shortly after 
it is made, or must be kept very cold, when the proc- 
ess is retarded ; or it must be quickly raised to the 
boiling point, which entirely destroys the activity of 
the ferment. 

Put two tablespoons of cold water in a goblet or 
glass; dissolve in this the powder contained in one of 
the Fairchild peptonizing tubes, then add fresh cold 
milk to fill the glass; stir the mixture thoroughly, 
and drink at once. 

Warm milk may be used instead of cold, when 
the process of digestion will be carried a little further. 

If the milk with the powder is brought rapidly 
to the boiling point, further digestion will be checked 
and the sweetness will be retained. The difficulty 
is that the flavor of the milk may change unless this 
is very carefully prepared. The bitter taste which 
develops does not indicate any harmful change in the 
milk, but it may be less pleasant to drink. 

To two cups of blood-warm milk add one dessert- 
junket spoon of liquid rennet. This should stand in a 
moderately cool place, until it sets in a curd, when 
it may be chilled. It may be varied by the addition 
of sugar, and flavoring in the form of coffee, co- 
coa, or wine. It may be served with or without 
cream. 



AILMENTS OF PREGNANCY 215 



men 
water 



Half a pint of cool water and the white of an Aibu 
egg are shaken thoroughly in a sealed jar. A little 
salt, sugar, or lemon-juice may be added to make 
the dish palatable. 

Cut half a pound of steak about three-quarters of 
an inch thick from the top of the round. . Wipe the Broiled 
meat, remove the fat, and sear over hot coals, in a essence 
pan or in boiling water. 

After continuing this cooking for about three 
minutes, cut the meat in small pieces and gash two 
or three times on each side. The juice may be 
pressed out either with a lemon-squeezer or with a 




A Meat Press 



machine especially made for the purpose. Season 
with salt and serve cold. If it is reheated the juice 
is very liable to coagulate. 

Cut in one-third inch strips a small piece of 
steak from the top of the round. Scrape, season with Scraped 
salt and pepper, and spread over thin bread-and- sandwiches 
butter sandwiches. Remove the crusts and cut in 
triangles or fancy shapes. 



216 MOTHERHOOD 

SPECIAL RECEIPTS— IN DIARRHCEA 

Mix two teaspoons of Bermuda arrowroot in cold 
Arrowroot water, to form a thin paste. Add to one cup of boil- 

gruel 

ing water, and cook ten minutes. Season with salt 
and add cream if desired. 

The addition of half a stick of cinnamon gives a 
little more character to an insipid gruel, and the spice 
tends to restrain the action of the bowels. 

A little caution should -be used in giving an excess 
of starches in liquid form, because they do not re- 
main in the. mouth long enough to come into contact 
with the digestive fluid, and so are passed along to 
the intestines, giving them an extra amount of work. 
If this caution is kept in mind and the liquids are 
held in the mouth for a moment and mixed with the 
saliva, their digestion will at least begin. 

Scald two cups of milk and add one Boston cracker 
Cracker rolled and sifted. Cook in a double-boiler for five 
grue minutes. Salt to taste. 

Cut bread in thin slices, put in a pan and -dry 
Toast water thoroughly in a slow oven. Break in pieces, add an 
equal portion of boiling water and let it stand for 
one hour. Strain and season. 

Wash thoroughly a dozen and a half of clams. 
Clam-juice Cook in a covered kettle with three tablespoons of 
water, till the shells open. Remove the clams and 
strain the liquor through a double cheesecloth. 

SPECIAL RECEIPTS— IN CONSTIPATION 

The coarse breads, as I have said, are especially 
beneficial in constipation. Bran biscuits recommend 
themselves on this account, though they are not a 
particularly palatable article of food. The graham 



AILMENTS OF PREGNANCY 217 

biscuits depend solely upon the heat for their light- 
ness, and should be simply two crusts if they are 
properly made. 

Mix together one pint of bran, half a pint of flour, Bran 
and one even teaspoon of baking soda. Add this to 
half a pint of milk and six tablespoons of molasses. 
Bake in gem-pans. 

Two cups each of graham flour and cold water. Graham 

* ° biscuits 

Mix well, add half a teaspoon of salt, and drop into 
hot buttered gem-pans. Bake in a very hot oven. 



10 Vol. 3 



Ill 



PREPARATIONS FOR CONFINEMENT 

Preparations for the Mother— Baby's Wardrobe— List of Clothes— The 
Nursery Furnishings 

PREPARATIONS FOR THE MOTHER 

IT IS well to begin the preparation of necessary 
things early, because their making often seems 
more of a burden later, when the increased weight 
and size make it difficult to move about. 

It is perfectly possible to keep the mother and all 
cieanii- her surroundings clean and comfortable during and 
comfort after delivery, and it is equally possible to make that 

possible 
during 



period one of discomfort and uncleanliness. Much 

and after depends upon the preparation she has made, and 

upon the understanding of those who care for her. 

She should have five or six dozen — more rather 

The num- than less — napkins or sanitary pads for herself. 

makiag These should be burned after use, and therefore 

sanitary should be made either of old linen or soft muslin, or 

pads f cheesecloth and absorbent cotton. These latter 

will cost about four cents apiece if made at home. 

The cheesecloth or gauze should be cut in half-yard 

squares, and folded with absorbent cotton inside. 

With pieces of cheesecloth one-half yard wide 
it is quite possible to make the napkins without sew- 
ing. In the larger drug stores one can buy rolls of 
absorbent waste, which serves as well as the regular 
absorbent cotton and is ten cents a pound less in 
price. The pads should be made of two grades, two 
dozen two inches thick being needed for use while 
(218) 



PREPARATIONS FOR CONFINEMENT 219 

the discharge is profuse. The others may be half the 
thickness. 

These pads should be sterilized by steaming for 
an hour, and then drying in a hot closet. The best How to 
plan is to wrap these in packages containing six, in the Vani- 
squares of muslin. Then they can be conveniently tary pads 
sterilized and only one bundle opened at a time as 
they are needed. If a regular steamer is not avail- 
able the dressings may -be wrapped in bundles and 
suspended from the cover of a wash-boiler — hang- 
ing just over the water. After the hour's boiling 
they may be taken out and dried without removing 
the wrappings. 

If quantities of old sheets are kept on hand, the 
regular bed-linen can be saved, and the washings Use of old 
made considerably smaller. One sheet may be used 
on the bed at the time of delivery, and burned after- 
ward. Others can be cut in squares, folded, and 
laid under the patient as a protection to the draw- 
sheet. Small pads are more easily washed, and can 
be changed when soiled with less inconvenience to 
the patient. 

Pads to use under the mother during labor are 
made of cotton or jute or other absorbent material. Use of 
They should be about three inches thick and two or l^dl 1Z 
three feet square. If several of these are prepared 
they can be used to absorb the discharges and to 
protect the bed. They should be sterilized with the 
other dressings. 

The majority of physicians require an abdominal 
binder as a support for the contracting uterus, and How to 
for comfort as well. This should be made of un- abdominal 
bleached muslin, a straight double band about four- binder 
teen inches wide and long enough to go about the 
body, lapping several inches. Three will be enough 



220 



MOTHERHOOD 



The use 
of short 
night- 
gowns 



The rub- 
ber sheet 

and its 
substitute 



The need 
of a bed- 
pan 



if they can be washed often. It is generally con- 
sidered necessary to wear them about five days, 
although sometimes the comfort of a firm support 
around the body is so great that they are kept on 
till the patient leaves her bed. 

Unless short night-dresses are very distasteful 
and uncomfortable, it will be found extremely con- 
venient to cut off the skirts of two or three old 
gowns, open them down the front, and use them 
for the first two or three days after confinement. 
The discharge is profuse, so that if the night-dress 
is pulled down behind it will surely be stained, and 
the frequent changing is rather an exertion at the 
first, while the short gown can be slipped on very 
easily, with no straining at all. It may be necessary, 
if one of these garments is worn, to keep a small 
piece of cotton blanket or outing flannel spread di- 
rectly over the knees, since the exposure is unusual. 

A nightingale, or loose dressing jacket, and bed- 
room slippers will be needed. 

A rubber or oilcloth sheet to protect the mattress 
should be three feet wide and long enough to stretch 
across the bed and tuck in or pin at the sides. The 
oilcloth is less expensive, and serves equally well, 
though it very quickly becomes cracked and worn. 
A pad of newspapers may be used in an emergency, 
and answers the purpose very well if made thick 
enough and carefully placed. 

A bed-pan is needed, and it is well to avoid the 
old make, very low front and having an outlet in 
the back, for it is almost impossible to use it without 
spilling the contents in the bed. The regular douche- 
pan is very satisfactory from the nurse's standpoint, 
but some patients find it exceedingly uncomfortable. 
The "Eureka," a small pan, or the "Perfection," are 



PREPARATIONS FOR CONFINEMENT 221 

both comfortable and convenient, which make their 
price less objectionable. 

A fountain syringe is also a necessity, and the 




"Eureka" Bed-pan 

douche-points should, if possible, be of glass, with tai n 
three outlets in the tip, since these are superior in s y"nge 

tr ' r and glass 

every way to those of hard rubber. It is easy to tell douche 

points 




"Perfection-;' Bed-pan 

when these are clean and they can be made perfectly 
sterile by boiling. 

THE BABY'S WARDROBE 

In the preparations for the baby it should be kept 
in mind that the object of clothing is to protect the Protect 
little body without impeding motion. A baby is D ody ayS 
almost constantlv moving:, and bv this exercise the w,th ° ut 

°' -' impeding 

muscles are growing strong and are gaining their its motion 
full development. Consequently clothing that re- 
stricts is just as injurious in its way as insufficient 
food. 

Simplicity is the next note to sound, for while 



222 



MOTHERHOOD 



Let the 

baby's 

clothes be 

simple; 

never 

elaborate 



Daintty 
materials 



Varieties 
in flannel 



The flan- 
nel bands 



Substitutes 
for the 
bands 



daintiness associates itself instantly with babyhood 
it is the simple rather than the elaborate daintiness 
which the clothing should express. The washing for 
a baby is no small consideration, and for this reason, 
if for no other, many frills and embroideries should 
be avoided. It is much more essential that a baby's 
clothing should be kept clean than that his petticoats 
should be trimmed or that there should be tucks and 
embroidery on his dresses. If one wishes to spend 
a deal of time and money in preparation it is pos- 
sible to put both into the quality of the fabric and 
the exquisiteness of hand-work. 

Nainsooks and dimity are the dearer materials, 
while Lonsdale or the fine-barred muslin makes less 
expensive dresses. 

The flannel, too, may range from the silk and 
wool stuff, at a dollar a yard, to outing cloth, at ten 
cents, and one can pay seventy-five cents apiece for 
silk and wool shirts, or make them of flannel for 
about ten cents. 

There should be four flannel bands, eighteen 
inches long and five inches wide. It is better to have 
them unhemmed, so that they may fit smoothly, for 
a baby's skin is so easily chafed and creased that 
all ridges and roughnesses in the clothing should be 
avoided. 

The bands may be left with raw edges for after 
washing the flannel fulls, so that there is little 
danger of raveling; or they may be finished with 
button-holing, which certainly makes them more at- 
tractive. Physicians differ as to the desirability of 
their use, and tight bandaging is no longer approved, 
the use of knitted bands, like little sleeveless shirts, 
being substituted for the flannel ones after the cord 
is off, and there is no need of a dressing. 



PREPARATIONS FOR CONFINEMENT 223 

The diapers may be of cotton or linen diaper 
cloth, or of Canton or cotton flannel, the latter being The dia- 
rather the most inexpensive. These should be cut how to 
square, as they can then be folded more easily. It ma e 
is a good plan to make them in two sizes, small ones 
for first use being eighteen inches square, and the 
larger ones twenty-six inches. The small ones can 
be used to supplement the larger size when the baby 
is older, and they are much less clumsy at first, 
when all the clothing is hopelessly ample. 

It is wise to have some small pieces not larger 
than six inches square to use till the bowels have 




Baby's Band 

discharged the first black, tarry substance that fills Small 
them at birth. These may be old pieces of napkins oiTtaMe 
or table linen, and can be burned, as washing them jj" e e " t ^ t 
is extremely difficult. 

As a matter of fact a great deal of labor can be 
saved if these pieces are always put inside the diaper 
to receive the discharge from the bowels. Thev may „ . 

° J J Such use 

be made double, and can be more easily rinsed out also later 
and washed than the bulkier napkins. There should 
be between three and four dozen diapers, the number 
depending upon the facilities for washing. 

Ribbed shirts of silk and wool are very dainty 
and very expensive, and the all-wool shirts shrink a The baby's 
little in time, even with very careful washing. Cot- 



224 MOTHERHOOD 

ton and wool is more serviceable and less expensive 
although hardly as warm. The only kind left to con- 
sider seems to be the little flannel sack with long 
sleeves, which can be cut after the pattern of the 
night-gowns, or even more simply, as shown in the 
cut. These sacks are very satisfactory, though of 
course they add somewhat to the work of prepara- 
tion. Four of these little garments are enough, for 
they are very easily and quickly washed and dried. 
A little Most of the mothers of the present generation 

sleeved use d to wear little fine linen or muslin shirts, low- 
ne d ked W " nec ^ e< ^ an d short-sleeved, in their own babyhood, 
garment and very often they will have one or more of them 
days in their possession. While we can not advocate their 




Baby's Shirt 

use as a regular habit, they are often of service dur- 
ing the summer if the baby is troubled with prickly 
heat or any such eruption. 

Remembering our statement that freedom of 
Condemna- motion is an important point to consider in preparing 
oidpinning tne baby's wardrobe, we must at once condemn 
and^tti- ^ e old-time pinning blankets and petticoats with 
coat with bands. They are awkward to put on, and it is almost 
their sub- impossible to make them secure without pinning them 
too tight. It is much better for the baby and easier 
for the mother to put on dress and petticoat to- 
gether, and this is quite possible if the latter is made 
like a sack gown without sleeves, buttoning behind. 
There should be four of these made, as I said 



stitute 



PREPARATIONS FOR CONFINEMENT 225 

above, either of silk and wool, all-wcol. or outing 
flannel. They can be made dainty to any degree, The mak- 
with embroidery about the hem and with the edges sack gown 
of neck and arms eye-scalloped and button-hole 
stitched, or they can be plain and simple, but they 
should if possible be finished with flat seams, opened 
and cat-stitched, so that there will be no ridges to 
make the baby uncomfortable. The skirt need not 
be longer than is necessary for warmth. Thirty- 
two inches from neck to hem ought to be sufficient 





Band Skirt 

length. Only one of these need be worn at a time, 
and no white skirt is needed. 

The little dresses may be made by a simple sack 
pattern, or with yokes. The yoked gown gives more The sim- 
opportunity for trimming, but the sack seems more dresses e 
suitable for the first slips. These can be finished 
with a bit of lace in neck and sleeves, and they do 
not represent the amount of labor in the making and 
after that the trimmed dresses do. Cleanliness, let 
me emphasize again, is the essential, 'and anything 
which makes that more possible should be considered. 

The number of dresses, as is true of all the articles, 
depends upon the amount of work, time, and money T e h r e n f um " 
that the mother is able to give. One can keep a baby s° wnB 



226 



MOTHERHOOD 



fresh and clean with very few changes, if frequent 
washing is possible, but slips wear out quickly, and 
it may be as well from an economic standpoint to 
have a generous supply. Eight is a good number, 
and of these the plainest can be used in the summer 
for night-gowns when the flannel ones are too warm. 
They should be only a trifle longer than the petti- 
coats. 

Here we have the baby dressed, with due regard 
for both comfort and health. The little band, put on 





Petticoat 



Dress 



A dress 
for baby- 
founded 
on com- 
fort and 
health 



A flannel 
night-gown 



firmly, but not too tightly, the shirt and diaper, then 
the petticoat and dress, all supported from the shoul- 
ders, complete a costume which provides for the 
necessary activity of a growing child, which can be 
adjusted without discomfort to him or inconvenience 
to the mother, and which can he kept in order with 
comparatively little labor. 

At night a flannel night-gown should replace the 
petticoat and dress. Outing cloth is quite suitable 
for this, for the change is as much on the ground of 
fewer coverings as of more warmth. The one loose 



PREPARATIONS FOR CONFINEMENT 227 

dress gives a little more room for relaxation, and it 
will also be found that it will save laundry work. A 
slip and petticoat can be aired and often can be used 
again if they are not worn during the night. 

Socks are rather unnecessary unless one finds 
it difficult to keep the house warm enough and the Socks if 
haby's feet are inclined to be cold. It is almost im-f e etare yS 
possible to keep a premature baby sufficiently warm, cold 
and socks are very useful in such a case. 

A warm coat for winter and a thin one for sum- 
mer are necessary, for a baby should not be deprived ^J^J? 
of his fresh air out of doors at any season. The a summer 
coat may be made of cashmere, or silk and wool 
flannel, or of eider-down or corduroy. Thinner stuffs 
should be lined and padded for winter weather. 

Close caps to match the coat in weight, and in 
winter in material also, can be bought ready-made, The little 
or can be made in the home. Nothing is daintier close cap 
than the little old-fashioned embroidered caps that 
our grandmothers used to make for their babies, and 
some young mothers are fortunate enough to have 
those among their possessions. 

If a covering is required for warmth in the early 
morning or when for any reason the baby is exposed, A loose 
a loose flannel wrapper or little kimono will be very wrapper 
convenient. These should be made ample, and the 
material may be soft cashmere, outing flannel, nun's 
veiling, or challis. The kimono pattern is as pretty 
as any, with the hem of folded silk. Feather-stitch- 
ing and French knots make an attractive finish. 

Bibs are useful from the first of a baby's life, 
especially if vomiting or regurgitation is common, The little 
and they are quite essential later when teething be- 
gins and the saliva flows almost constantly from his 
mouth. They can be bought for very little, but if 



228 MOTHERHOOD 

simply made they will be even less dear if done at 
Their home. A quilted cotton lining is necessary, or a 
layer of wadding may be laid between lining and out- 
side and quilted together. The outside may be of 
lawn, cambric, or stout diaper cloth, and may be 
trimmed or plain. The dainty linen bibs, lace- 
trimmed and embroidered, are largely decorative, 
though perhaps they offer a little protection to dress 
or cloak if no such calamity as drooling or vomiting 
occurs. About twelve bibs will be necessary. 

The "Gertrude" patterns are very satisfactory, 

in using but the outfit bearing that name includes both a long- 

trude" er sleeved flannel slip and a petticoat or sleeveless slip 

patterns as we u With a band, shirt, and flannel skirt coming 

from the shoulders a baby does not need another 

woolen garment. 

Several squares of flannel made from one width of 
The baby's the goods may be bound with wash ribbon or silk 

blankets & J 

tape, and are very useful to wrap the baby in for 

his bath or to put about him in bed. 

A large piece of old blanket should be provided 
The blank- to put him in immediately after birth. He may be 
birth m kept wrapped up in this till he is oiled and dressed, 

and then the blanket can be burned if it has been 

badly soiled. 

In caring for a baby one of the most practicable 
a knitted coverings is a blanket about crib-size loosely knitted 
Shetland f Shetland wool. It may be doubled, and is still 

wool 

blanket soft enough to wrap about the little body when one 
is carrying him from room to room. It is very con- 
venient as an extra bed covering,' and tucks in about 
the small person very cosily in his carriage. 

The towels should be either of soft old damask 

The baby's or f cotton diaper which has been washed till the 

towels . „ . . . a 1 • i • 

stiffening is quite out. A dainty towel is made by 



PREPARATIONS FOR CONFINEMENT 229 

finishing the ends with button-holed scallops instead 
of the commonplace hem. 

A sponge can not be kept absolutely clean, and 
it is much better to use a soft cloth. A bit of old a soft 
flannel or woolen shirt answers the purpose yery ter than 
well. The pores of a sponge gather dirt and form a sponge 
a breeding-place for germs, and, in spite of care, it 
can not be kept free from all trace of living organ- 
isms except by impracticable methods of steriliza- 
tion. 

LIST OF CLOTHES 

8 Bands 4 Night-gowns 

48 Diapers 2 Wrappers 

4 Shirts 3 Blankets 

4 Knitted Bands 2 Caps 

4 Sleeveless Flannel Slips 2 Cloaks 

8 Dresses 12 Bibs 

Borated talcum powder is a reliable sort to use 
on a baby. Cornstarch may be substituted, but Powder 
owing to its tendency to absorb water it is liable H°[i e body 
to become caked on the skin and is not so readily 
removed. 

The soap should be a pure castile or ivory. There 
are few purer soaps on the market than the ivory, Need of 

• , r mi P ure soaps 

and it possesses the advantage of being easily ob- 
tained and of little cost. 

There should be safety-pins of three sizes, and 
care should be taken to buy those with sharp points. The kinds 



There are often a good many thicknesses to pin 
through, and there is much less danger that the pin 
will slip and prick the baby's flesh if it goes in eas- 
ily. If the pins fasten from either side a good 
deal of labor is saved, and every little counts in the 
care of children. 



of safety 
pins 



230 MOTHERHOOD 

Ten cents' worth of boracic acid powder will 
The baby's serve for a wash for eyes and mouth, and it is con- 
and infuse venient to have a special cup or bowl for the solution. 
The cup may be of white enamel, which is easily 
cleaned, and may be put over the fire or gas flame 
if a little hot water is needed. Small squares of soft 
muslin or handkerchief linen or bits of absorbent 
cotton can be used to wash the eyes and mouth. The 
cotton is rather more convenient, but if it is not at 
hand the little squares answer the purpose. 

THE NURSERY FURNISHINGS 

It is far better to have a separate bed of some 
The baby's sort for the baby than to keep him with the mother. 

separate J « 1 , . 

bed There are of course elaborate bassinets, but as we 

are aiming at moderation in the cost of our prepara- 
tions we may dismiss those with a word. They are 
dainty in their design and decorative as room fur- 
nishings, and are convenient besides, but at best they 
are of temporary use, for a baby soon demands more 
space asleep and awake, and if they are to remain 
looking fresh they must be renovated before many 
months. 

A clothes-basket makes a cosey bed for the little 
one, and it may be set on a standard to bring it to a 
convenient height, but it is soon outgrown unless 
the baby is abnormally small. A crib is most satis- 
The crib factory and it is really as well to buy that at the first 
clothing so that all the bed linen may be made for it, and 
there need be no thought of changing it till the child 
is quite grown. It should be made up like an ordi- 
nary bed, with sheets and blankets, and a very flat 
pillow, which may be made of two or three layers of 
absorbent cotton sewed into cheesecloth and covered 
with a little case open at each end. This pillow raises 



PREPARATIONS FOR CONFINEMENT 231 

the baby's head enough, and may be destroyed if it 
becomes badly soiled or soaked. 

A square of rubber should be kept over the lower 
sheet. Pads of canton flannel made of several thick- The rub- 

i i~ i i j Der square 

nesses and quilted firmly, or of absorbent cotton and 
cheesecloth, can be easily washed, and with the rub- 
ber square thoroughly protect the mattress. No 
spread is necessary for the little baby, but when he 
is old enough to be out of his bed a part of the day 
a dimity coverlet is suitable. 

In buying a bath-tub it is well to follow the sug- The metal 
gestion made with regard to the bed, and to get one 
large enough to serve for some years. The tin tubs 
meet every demand, except, perhaps, the aesthetic, 




White Enamel Bath-tub for Baby 

which is better satisfied with those of white enamel. 
The latter are much more expensive than the tin 
tubs, but will also last longer. 

A very convenient but not especially durable tub 
is the one made of rubber sheeting fastened on a The rub- 
folding frame. It stands at a good height and i„g tub* ' 
when not in use takes up very little room. If the 
rubber becomes cracked in any way the tub is quite 
useless, but with care they often last as long as those 
of tin. Their durability depends largely upon the 
care that is given them. If they are used as catch- 
alls, some hard or sharp object is very likely to punc- 
ture the rubber. If they are not dried properly after 
use, or if they are kept in a very cold room part of 
the time, they soon crack. 

It is possible, of course, to fit out the baby with 



232 



MOTHERHOOD 



most elaborate toilet paraphernalia. A white enamel 
The white tub, bowl, and soap dish, with powder puff and pin 
fittings tray also in white, may stand on a round white table. 
This brings the tub at the right height for the mother 
sitting in a low chair, and gives room when the bath 
is over for the basket containing various other baby 
belongings. 

A small clothes-horse painted with white enamel 
White fur- j s extremely useful, and with the crib and a white 

nishings . 

chiffomere or bureau complete the nursery furniture. 




Rubber Tub 



The basket may be elaborately decorated with 
The baby's frills of muslin over colored silk or sateen, or it 
and its may be quite unadorned. But it should contain a 
pincushion stocked with threaded needles, a spool 
of thread, a thimble, and a pair of blunt-pointed scis- 
sors. The brush and comb, little studs or pins for 
the dresses, and the bands rolled ready to put on, 
may also be kept in it. It is possible to get on with 
very few accessories, but on the other hand we must 
remember that preparation and equipment that make 



PREPARATIONS FOR CONFINEMENT 233 

for case and convenience are economic from the 
standpoint of time, labor, and nerve strain. 

If the baby has these individual belongings much 
less time will be spent in looking up the little gar- Gain from 
ments and putting them together before the bath is equip- 
given, and the spotlessness of white enamel is in [^"baby* 
itself an incentive to cleanliness and order. It takes 
much less time also to keep such ware in good con- 
dition, and, besides, non-absorbent materials are much 
more sanitary to use about a baby. 

The belongings of the child should never be used ^" ar b ^ g ' 
by any other member of a household. He is usually things 
very susceptible to disease and can be protected from ers* use 
it to some extent if ordinary care is taken. 

In choosing a room that shall be given up to the 
baby's use it must be kept in mind that the larger in choos- 
part of his life during babyhood is to be spent there, baby's 16 
He needs fresh air and sunshine more than any plant room 
does, in proportion as his organism is more complex 
and delicate. YVe may not see results as immediately 
in the child, but he can not live in an ill-lighted, ill- 
ventilated room without feeling the effects of this 
vital lack. 

The homes where a nursery can be set apart are 
comparatively few. but this rule applies to any part Xeed of 
of the house where the baby lives. He should never and sun- 
be allowed to sleep in an inner room, or in one which lg * 
is not constantly receiving a supply of pure air. The 
windows may be darkened while he takes his naps, 
but he should spend his waking hours in sunlighted 
rooms. 



IV 

LABOR 

Duration of Pregnancy— Preparations for Confinement— Stages of Labor- 
Contractions ot the Uterus— Emergencies— After-treatment 
of Mother— After-treatment of Baby 

DURATION OF PREGNANCY 

THE duration of pregnancy is two hundred and 
eighty days. The usual method of computation 
is to count back three calendar months from the date 
of the cessation of menses, and then add seven days. 
The meth- This gives a date that approximates the correct time 
computing as closely as possible. Example : Menstruation ceased 
date of June I ; counting back three months brings us to March 
ment i ; and adding seven days gives us March 8 as the 

probable date of confinement. Children may be born, 
and live before the end of that time, and there are 
records of pregnancies which lasted as long as twelve 
months. 

During the last two weeks there are usually some 
Premoni- premonitory symptoms, which may serve as a guide, 
torysymp- j£ j t k as k een impossible to make an accurate reckon- 

toms ot x 

confine- ing. The uterus sinks in the pelvic cavity, the abdo- 
men consequently diminishes in size, and the palpi- 
tation and difficulties in breathing are consequently re- 
lieved. The increase in pressure on the lower bowels 
and bladder are greater, however, and there are fre- 
quent evacuations. 

The provisions for the support and nourishment of 
Marvels of the child in the uterus are very wonderful, and it may 
pregnancy , k e we u |- consider for a moment the marvelous ar- 

(234) 



LABOR 235 

rangement by which it is retained there for the term 
of nine months and expelled at the end of that time. 

In the first place, the after-birth, or placenta, is at- Nature's 
tached to the uterine wall, and is brought into close Intent ° US 
contact with the uterine blood-vessels, so that the blood gence , m 

nourishing 

stream of the mother supplies its vessels, and, through and P r °- 

i r i r * , m 1 • tectingthe 

it, the circulatory system of the fetus, as the child is unborn 
called during its life within the womb. This nourish- a y 
ment by the blood of the mother is accomplished 
through the cord which extends from the navel of the 
fetus to the placenta, and is simply three large blood- 
vessels inclosed in a jelly-like substance. Finally the 
fetus itself is floated in a membranous sac of liquid, 
which effectually protects it from external shock. 

The causes that normally bring about the birth of a 
child, at the end of nine months, are not fully under- At full 
stood. The statement most generally accepted is that men t the 
the uterus has reached its full development, and the "f"^ 8 
pressure of its contents stimulates it to contractions ; uterus 

* contract 

but there is doubtless besides an increase in the irrita- and the 
bility of the muscular tissue, and a consequent quick- born 1S 
ening of the sensitiveness in the nerve-supply at this 
period, which are not wholly comprehensible phenom- 
ena. Whatever the exact source of this stimulation 
may be, its effect is to cause the muscles of the uterus 
to contract with so much force that the membranous 
sac is ruptured, the after-birth is loosened from its at- 
tachment to the wall of the womb, and the child, with 
these accompanying membranes, is expelled. 

During the course of pregnancy, there may be an 
occasional pain through the abdomen, but these are " Fals ,^ 
usually spoken of as "false pains," and can be relieved 
by a cathartic or an enema. The true pains are first 
felt in the back, and though it is quite possible to be 
misled in regard to false pains, when labor has really 



236 MOTHERHOOD 

begun there is rarely any doubt about it. A true labor 
Character pain is a contraction of the uterus, followed by a pause, 
labor" 6 during which there is relaxation. These pains come 
pains at regular intervals, at first very short, while the in- 

tervals are long, but gradually growing longer and 
more severe, till they follow each other with almost 
no pause at all. 

PREPARATIONS FOR CONFINEMENT 

When the premonitory pains begin, there are cer- 
tain preparations which will help to some extent at 
the time of delivery, and will make the period in bed 
rather more comfortable. Often slight pains are felt 
The bath many hours before the birth of the child, so that there 
when the is time enough for the bath to be taken, and for the 
pafrls are ^ed to be made, before it is necessary to lie down. It 
felt is a distinct advantage for the bowels to be thoroughly 

evacuated, and an injection of warm soap-suds should 
be given, unless they have already moved by the action 
of a cathartic. 

Arrange the hair in two braids, which may be 
The hair pinned up out of the way if necessary. After the 
gown" 18 bath the night-dress should be put on, with a loose 
bath wrapper over it, so that there need be no delay 
in getting to bed, and no complicated garments to 
loosen when the severe pains begin. Long stockings, 
reaching well above the knees, may be kept on for 
protection and warmth. 

The maternity bed is made very like the one pre- 
The mater- pared for an invalid, as described in foregoing pages, 
mty bed ^ it . g ^ ^ w bedstea( ^ ft } s a g- reat convenience to have 

it set up on blocks a foot and a half high. Any car- 
Disadvan- penter can make them, with a slight depression for 
lobbed a the casters, so that the bed will stand firmly. At the 

time of delivery, the doctor can work over the patient 



LABOR 237 

much more easily if he can stand more nearly erect, 
and it is also a great advantage for the nurse to have 
the bed high. The lifting and rubbing, combing the 
hair and bathing are very difficult for a person of 
even average height, over a low bed, and the muscles 
of the back are under constant strain. Because of this 
the patient is more conscious of the effort, and so is 
indirectly affected by the attendant's discomfort. 

The lower sheet, rubber, and draw-sheet are put on 
in the usual way, but at the time of confinement an Value of 
extra oilcloth or rubber and a sheet are to be spread, oil or rub- 
f rom the top of the draw-sheet to the foot of the bed. ber sheet 
This securely protects the mattress and lower sheet, 
and after the birth of the child, can be entirely re- 
moved, leaving the patient on a clean bed. 

Before the doctor comes, plenty of water should 
be put on to boil, and soap and towels for his hands Necessi- 
must be ready. There should be a vessel to receive conven- 
the after-birth, and two basins of agate or enamel ware ^doctor 
will be needed. The bed-pan and fountain syringe and 
a fresh jar of pure vaseline must be at hand. 

It is well to be provided with two large bowls 
of some sort, large enough to hold the baby. Some- Bowls for 
times if the labor is prolonged, it is difficult to estab- case The 
lish the baby's respiration at first. The lungs have b f b / t ' ion r - s s " 
never been of use till he comes into the world, and the difficult 
first gasp of air he takes has to open little air-sacs that 
have never before been expanded. If the breathing 
is delayed, a sudden shock, like a plunge into warm 
and then cold water, is general^ effective, and it is 
well to be prepared for this possibility. 

Other necessaries are disinfectants — carbolic and 
bichloride — a bath-thermometer, a clean nail-brush for other 
the doctor's use, and some sort of tape — Dutch tape or necessanes 
bobbinet — for tying the cord. It is well to inquire 



238 



MOTHERHOOD 



from the doctor just what supplies he will bring him- 
self, as it may save a useless duplication. 



The three 
stages of 
labor 



Character- 
istics of 
pains 
of the 
first period 



Discour- 
agement 



Encour- 
agement 



Nourish- 
ment 



One fun- 
damental 
prin- 
ciple of 
nursing 



STAGES OF LABOR 

Labor is commonly spoken of as being divided into 
three stages, the breaking of the water usually indi- 
cating the end of the first. The second terminates with 
the birth of the child, and the third with the expulsion 
of the after-birth. 

During the first stage, the pains are very severe, 
comparable only to the most intense suffering during 
menstruation, and are caused by the contractions of the 
uterus as it seeks to rid itself of its contents. These 
pains are rhythmic, coming at very regular intervals, 
and with increasing frequency. It is better for a wo- 
man to walk about between them, because the exercise' 
stimulates the uterus to more frequent contractions. 

This is the most discouraging period, because the 
pain seems so unavailing, and because, especially at 
the birth of the first child, it may last for many hours. 

The cheering voice and the encouraging word are 
especially helpful just here, for though the pain must 
be borne alone, there are little devices that make the 
burden lighter. A drink of water now and then is 
grateful, even if the need of it is not realized, and 
if the labor is prolonged the nourishment should not 
be neglected. A cup of soup or milk will keep up the 
needed strength, and prepare the woman for the sec- 
ond stage, when there is definite work for her to do. 

And just here let me emphasize one fundamental 
principle of nursing : When food is to be administered, 
it should not be mentioned until it is ready to place be- 
fore the patient. 'Nine times out of ten it is refused, 
because the mind has had to make the choice, and 
dwell upon it while it is being prepared. A woman 



LABOR 239 

will rarely ask for food in the midst of her labor pains, 
but she will generally take some simple nourishment 
if it is brought to her, and she will feel better for it. 

After the "waters'' have "broken," which signifies 
that the sac of fluid in which the baby has rested has Care of 
been ruptured by the pressure downward against the at the end 
neck of the uterus, the mother should at once lie down. ^st'Sage 
This expulsion of the fluid generally indicates that the 
mouth of the uterus has either opened or become 
softened and ready to open ; and this opening marks 
more exactly the end of the first stage than the rupture 
of the sac of w r ater, though the latter is commonly an 
accompaniment, and the only apparent sign. Before 
lying down in the bed, the night-dress should be drawn 
well up about the hips, so that it may not be soiled by 
the discharges. Care must be taken to keep the breasts 
protected and the entire body sufficiently warm. 

With the beginning of the second stage, the char- 
acter of the pains changes, and though they may be Character 
more severe, they seem always easier to endure. They of the^ec- 
are spoken of as "bearing-down pains," and now the ond stage 
woman can help along by the straining effort which 
she will instinctively make, and by taking a rest in the 
intervals of quiet. 

The nurse or attendant can help her, too, first, by 
giving her something to pull on, like the ends of a How the 
sheet, which has been thrown over the bed-post ; sec- help at 
ond, by placing a box on the foot of the bed, so that thls time 
she can brace against it with her feet, and third, by 
pressing the hands firmly against the small of the back. 
In the period between pains, it is very grateful to have 
the face wiped with a damp cloth, especially if this 
stage of labor is prolonged. 

Immediately after the birth of the child the pains 
cease, and there is an interval of from twenty min- 



240 MOTHERHOOD 

The third utes* to half an hour before they begin again to bring 

labor or about the expulsion of the placenta. The placenta 

after-birth g^Qy}^ k e received in a vessel prepared for it, and it 

Need of must not be thrown away or disturbed until the physi- 

the doc- c i an has examined it. He can tell by its shape and the 

tor s ex- _ j r 

amination appearance of its surfaces whether or not it has come 

of the 

placenta away entire. 

If any portion of it remains in the uterus, that or- 
gan must not be allowed to contract firmly until every 
portion of the membrane has been expelled. After the 
doctor has finished his examination, it should be 
wrapped in thick paper and burned. 

Immediately after the birth of the child there may 
Chilis be a slight chill. This is due in part to nervousness, 
fabor and ar, d m P art to ^ e ^ act th at ^ e presence of the child in 
when the trie u terus has increased the bodily heat of the mother. 

milk comes J 

There is liable to be another chill on the third day, 
when the milk comes into the breast. A chill at any 
other time should be promptly reported. 

CONTRACTION OF THE UTERUS 

As soon as the uterus is empty, it should begin to 
contract, which prevents hemorrhage, and is the be- 
ginning of its return to normal size. The attendant 
Helping should place her hand over the abdomen after the 
to contract placenta has been expelled, and by making a kneading 
motion over the uterus she can help to its contraction. 
If it can be felt as a hard firm ball, just below the 
navel, it is in proper condition and need occasion no 
uneasiness. 

After-pains are due to contraction of the uterus 
To what after the birth of the child and the expulsion of the 
a:e e due ainS placenta. They do not occur after the birth of the 
first child, but are often very severe in later confine- 
ments, and sometimes last for three, or rarely for four, 



LABOR 241 

days. They are unaccompanied by fever or by any 
alarming symptoms. 

EMERGENCIES 

At the birth of the first child there is generally 
little danger of a rapid delivery, so that the possibility ^ ^ e . 
of the woman's being alone or with an attendant only al °ne how 
is slight. But in any case this need not be regarded retard 
as a terrifying calamity. The progress of labor can labor 
be retarded a little if she restrains her tendency to 
bear down during pains, and expels the air from her 
lungs with her mouth open, which relaxes the muscles. 
If the child is born, she needs only to see that his head 
is lifted up so that he can breathe properly, and that 
there is no tension on the cord. An attendant, whether 
or not a nurse, can lift the baby up, put a clean padwhattodo 
under him, see that he cries enough to establish respira- child tin 
tion, and cover both child and mother till the doctor comes 
comes. 

If the labor has come on precipitately, and the doc- ^[^ ^ nsi * 
tor can not be summoned, the nurse must assume the * he nu f se 

.,.-.-. 1 , lf the doc- 

responsibihty of cutting the cord. tor is not 

When it has quite ceased pulsating, a piece of presen 

bobbinet, which should have been previously sterilized 

with the other dressings in a package by itself, may 

be tightly tied around the cord in two places, one 

ligature being about four inches and the other two 

inches from the body of the child. In making the 

knots, which should be extremely firm, care must be Directions 

taken to keep the hands absolutely steady, as sudden Jj£ ^ g 

tension on the navel might result in rupture or even 

a fatal hemorrhage. 

After the two ligatures are made, the cord can 

be cut between them with blunt-pointed scissors, and Cutting 

the baby can be rolled in his blanket, and left without 

any fear of harm. _. , 

' ii Vol. 3 



242 MOTHERHOOD 

The flowing directly after delivery will be profuse, 
Action in but should it seem in any degree alarming, the con- 
flowing dition of the uterus should be at once investigated. If 
delivery ^ * s not ^ rm anc * hard feeling, as I have said, like a 
hard round ball in the abdomen, it is not contracting 
as it should, and that will explain the increased flowing 
of blood. If it is kneaded with the hand, or if a little 
cold water is dashed over the abdomen, it often con- 
tracts at once, firmly enough. 

Putting the baby to the breast also tends to bring 
The baby a b ou t contractions, and both these expedients should 

helping to r 

muscular be tried, though a doctor should be summoned if any- 
thing in the nature of a hemorrhage occurs. 

Special tenderness over any portion of the abdo- 
men, an offensive odor to the' discharge, or a return of 
the bright red color after it had become dark should 
be reported. 

Sometimes in a very difficult confinement, when the 

Cause of child is large, or the outlet is narrow, the tissues are 

lacerations tom during . the birth. The laceration may be in the 

neck of the uterus or in the tissues about the vagina, 

and often a physician will proceed with their repair 

without a question. 

If he does leave it to the patient, she should have 
Repair of n0 hesitation in choosing to have it attended to at once. 
tion at° e ' In that case the operation is a very simple one, and is 
bestcourse almost invariably successful, as the parts unite very 
quickly. Very unpleasant consequences follow the 
neglect of such an injury, the nerves being so closely 
involved that there is much sympathetic disturbance, 
such as headache and pain in the back, besides the 
actual discomfort of the laceration. A secondary re- 
pair means a much longer time spent in healing, and 
an extra period in bed with the attendant weakness. 



LABOR * 243 



AFTER-TREATMENT OF THE MOTHER 

After the placenta has come away, and the contrac- Cause of 

11" 1111 ^ ie c ' u ^ 

tion ot the uterus is assured, the woman should be 

closely covered, given a warm drink, and allowed to 

rest, for a nervous chill, described on foregoing page 

240, is likely to follow. This is caused in part by 

the evaporation of perspiration from the skin after the 

cessation of muscular activity, and is no occasion for 

alarm. It lasts a short time, and is relieved by the 

application of heat. 

After the patient has been bathed, the abdominal Full 

binder put on, and the soiled clothing removed from to the 

the bed, she will probably fall into a light sleep, when mother 

the attention of the nurse may be turned to the baby. 

AFTER-TREATMENT OF THE BABY 

The first task is to make a thorough examination First see 
of the child to see that it is normally developed. The ^ud * s he 
presence of external defects is at once remarked. The normally 

developed 

mouth should be inspected, because cleft palate and 
tongue-tie interfere with suckling, and can be corrected 
at an early age. The navel, of course, receives especial 
care, and the genitals and passage into the bowels Examina- 
should be observed, to make sure that there is no im- sp° e n ci fi f c 
pediment to the performance of natural functions. It P arts 
must be ascertained that the opening into the canal 
leading into the bladder is present, and that the rec- 
tum and anus are normal. 

Rarely in girl babies the passage into the vagina 
is found to be entirely closed by a membrane called the 
hymen, which stretches entirely across it. When this 
is the case, a very slight operation is necessary, and The 
may be done at once. The doctor has already applied of^e"* 
the dressing for the cord, which is simply a layer of cord 



244 MOTHERHOOD 

sterilized absorbent cotton, or pad of gauze. Over this 
he has put on the bandage, which should not be re- 
moved without his approval. It is not safe for any 
one who does not understand the principles of surgical 
cleanliness to attempt to do this dressing, since serious 
consequences, even blood-poisoning, might result from 
lack of proper precautions. 

The baby will be found to be covered with a white 
Removing cheesy substance, which was necessary as a water- 
cheeky 1 e proof protection, since the medium in which he lived 
coating was £ u -^ rat h er t j ian a } r# Albolene, olive oil, or pure 

vaseline may be used to remove the substance, and 
it is well to rub the ointment thoroughly over the sur- 
face of the body some little time before the bath is 
given. If this can be done, the warm soapy water will 
wash off all trace of it. 

Particular care must be taken to remove the cheesy 
Particular coating from the creases of the body, under the arms, 
this as in the groins and about the genitals, as it is very irri- 
coating ta ti n g if allowed to remain. The scalp, too, needs es- 
pecial attention, since after this substance hardens it 
is much more difficult to remove, and if it remains, it 
collects dirt, and becomes unsightly, if not diseased. 

After a thorough application of the oil, the baby 
may be wrapped in a warm woolen blanket, and left 
for several hours, if need be, without harm. It some- 
Letting t } mes happens that the mother needs especial care, and 
resteer if the baby is warm enough, and if his eyes are pro- 

the oiling tected f rom bright j.^ j t j s quite as wdl tQ put ff 

giving his bath and dressing him for four hours or 
so, after the oiling. It will be found that he is very 
easily cleaned after that length of time, because the 
white substance has become quite softened. He may 
then be dressed in a diaper, shirt, and flannel night- 
gown and allowed to take his first feeding. 



AFTER-CARE OF MOTHER AND CHILD 

Rest— Dressings— Breasts — Diet — The Baby's Bath — The Cord -dressing — 

Order of Dressing— Care of Eyes, Nose, Mouth, and 

Breast— Tub-baths— The Band— Feeding 

REST 

WE have spoken of the changes that have gone 
on in the uterus during the nine months of 
pregnancy. These have been not only changes in 
size and weight, but also in functional activity, which 
have involved the entire system. 

With the birth of the child, the immediate cause 
of this activity is removed, but Nature has now to re- Nature's 
adjust the organs that have been working under ab- me^o?" 
normal conditions, and especially to bring back the the or s ans 
uterus to its previous size and position. She accom- 
plishes the work usually in about six weeks, which in- 
dicates that the tissues are in a state of tremendous 
activity. This fact should impress upon our minds 
the necessity of rest during this period, or the greater 
part of it. It is marvelous enough that the system can 
recover its usual poise after such a long-continued 
strain, and even more wonderful to think of the rapid- 
ity with which the uterus contracts and gets rid of the 
extra tissue which it has taken nine months to acquire. 
It seems only fair that a few weeks should be allowed 
for the strengthening of ligaments and muscles, and ^fn 
for the building" up of tissues more or. less depleted * hat read * 
by the double burden they have carried. For these 
reasons three weeks in bed are better than two, and 

(245) 



246 



MOTHERHOOD 



Re-estab- 
lishing 
nervous 
and physi- 
cal tone 



unless a woman is very strong three will probably leave 
her in still better condition. 

For three or four days after delivery, the mother 
should be kept very quiet, lying most of the time on 
her back, especially if the discharge is profuse. Vis- 
itors should not be allowed to see her for at least a day 
or two. Quiet and rest re-establish the nervous and 
physical tone within a short time, and the rapid con- 
valescence is as remarkable as Nature's other methods 
of adjustment to changed conditions. 



Bathing 
parts with 
a mild dis- 
infectant 



Cleanli- 
ness and 
comfort 



DRESSINGS 

The napkins should be removed every three or four 
hours, for the first day. After that, every eight hours 
will be often enough. 

Each time they are changed, and after urination, 
the' genitals should be bathed with a mild disinfectant. 
This may be a bichloride solution made with one part 
of the I -iooo preparation with four parts of water. 
This bathing should consist chiefly of pouring the 
water gently over the parts, while the patient is still 
on the bed-pan, and then drying them before adjust- 
ing the fresh pad. 

This bathing will make for cleanliness and comfort, 
will remove disagreeable odors, and hasten the healing 
process. A separate piece of cloth should be put under 
the body before the bed-pan is used, and with the fre- 
quent changing of the pads, the bathing and the use 
of squares laid over the draw-sheet, it will be found 
possible to have a tidy bed, without too much extrava- 
gance in the way of laundry. 



BREASTS 

Care should be taken to cover the breasts, because, 
since at this time the glands begin to exercise* their 



MOTHER AND CHILD 247 

function of secreting milk, they are more susceptible 
to cold. An inflammatory condition may set up, and Protection 
become very painful, and by keeping a light-weight breasts 
bit of flannel over the breasts from the first, the dan- 
ger is avoided. It is well to keep a clean cloth — linen 
or cotton — over the nipples all the time, and to wash 
them with boracic acid solution after each feeding. 

The milk is manufactured by glands in the breasts, 
and it must be remembered that the nipples lead into cieanii- 
as well as out of these glands. If they are not kept breasts 
clean and covered, or if particles of the milk are al- 
lowed to remain on them and to decompose, the danger 
of infection is very great. An abscess is caused by 
infection, from some such reason, or because the milk 
within the breast is allowed to accumulate and become 
caked. 

If lumps are noticed in the breasts, the attention 
of the doctor should be called to them. Gentle mas- When 
sage will generally soften them, but unskilled manipula- fo™m S 
tion may be more harmful than beneficent. The mas- 
sage should be given with the palm of the hand, being 
a gentle circular motion from the base of the breast 
toward the nipple. 

If there is any tendency toward engorgement of the 
breasts, the baby should be put to nurse with especial I en- 
regularity, and in extreme cases the milk may have to 
be drawn out with a pump. Pumping tends to in- 
crease, rather than to restrict, the flow, however, so it 
should be a last resort. Liquids may be largely elim- 
inated from the diet, and if the child is a healthy one, 
this difficulty will soon be overcome by his necessary 
appetite. 

There is rarelv anv excuse for the formation of an Proper 

« .,,''.,. . rr^i care does 

abscess in the breast, if proper care is given. The away with 
bunches should be reported to the physician as soon as abscess 



248 



MOTHERHOOD 



Chapped 
or cracked 
breasts 



Washing 
the breast 
after each 
feeding 



Other 
treatment 



Care in 
treatment 



they appear, and they generally yield to massage. If 
they become inflamed, ice-bags are ordered, the bowels 
are kept open by the use of laxatives, and the child is 
taken from the breast. The chief danger lies in delay 
in telling the doctor of the trouble, and in beginning 
treatment. 

If the breasts have had no treatment during con- 
finement, and if the nipples are flattened at all so that 
there is constant tension during nursing, they some- 
times become chapped or cracked. This is intensely 
painful, especially since the baby must still be put to 
the breast so that the milk shall not accumulate. 

The prevention of this condition, as well as one of 
the cures, is cleanliness, which means that the nipple 
should be washed after each feeding, and in case any 
ointment or solution is applied, washing before feed- 
ing is also necessary. 

If the difficulty is slight, boracic acid ointment used 
after each nursing will often be sufficient. 

Painting the nipple with white of egg, applied in 
several coats is a help, because it shuts out the air, 
and gives the fissure a chance to heal. The same 
treatment may be tried with compound tincture of 
benzoin, but if the condition is obstinate, the doctor will 
probably touch it with a solution of nitrate of silver, 
twenty grains to the ounce, which greatly hastens the 
healing process. Two treatments daily are sufficient, 
and if left to an attendant, it should be done either with 
a camel's-hair brush, or with a very small swab of 
cotton twisted about a wooden toothpick. 

The solution should not be allowed to flow over the 
entire nipple, but only over the cracked surface. The 
effect of its use is to cauterize the edges of the fissure, 
and thus to make a fresher wound, which tends to heal 
more easily. 



MOTHER AND CHILD 249 

Unless the flow of milk is excessive, the breast may 
be given entire rest for twenty-four hours, which will 
often effect an entire cure. If this is not the result, 
some provision must be made to draw off the milk from 
the breast, because of the danger of abscess resulting 
from an over-accumulation. 

The use of a nipple-shield relieves the tension when 
the babv nurses. This covers the nipple with a glass The , 

rr , & nipple 

bell, having a rubber mouthpiece very like that of a shield 
nursing bottle. The disadvantage of its use is that 
the baby may become accustomed to the longer rubber 
nipple, and so may take the breast more reluctantly or 
refuse it altogether at first. 

DIET 

The diet of the mother for the first two days should 
be liquid. Milk is the best food, both because it is the 
most nourishing, and because it helps to increase 
the supply in the breasts. Tea and coffee tend to check Jittfltbor 
the milk supply, so they should not be taken unless the 
milk is secreted in excess. Cocoa, gruel, and soups 
will vary the fare, which may be increased after forty- 
eight hours to semi-solids, i. e., eggs, soft toast, cus- 
tards, etc., and after the first movement of the bowels, 
regular diet is allowable. 

If the bowels have moved just before the baby's 
birth, there need be no uneasiness if there is no evac- 
uation for two or three days. Then the doctor will 
order either a cathartic or an injection, and very often J^olv-eis 
after solid foods and fruits are given the stools will be 
regular and natural. The same care should be taken 
after confinement as before, to regulate the bowels, 
and to avoid the ills of persistent constipation. 

The daily care of the mother should be what is 
given an ordinary bed-patient. The daily bath, the 



250 MOTHERHOOD 

Daily care changing of bed-linen, and the putting her room in 
order should be attended to before the baby's bath 
is given. It is much more essential for the mother 
to start in her day with the cheer that attends clean- 
liness, fresh air, and order than for the child to have 
early attention. It is perfectly safe to give her a full 

Rubs and bath, between blankets, on the fifth day, and before 

baths 

that alcohol rubs and sponging will freshen her each 

day. 

There may be interested neighbors or relatives 

who will insist that her hair must not be combed for 

a week after delivery, and that all bathing is danger- 
Advice of ous. It is to be hoped that their counsel will not be 
neig ors f |j owe( j j t j s q U if- e unnecessary to neglect the 

patient in any particular, and if she is clean and 

decently cared for her recovery will be hastened 

rather than retarded. 

THE BA3Y'S BATH 

It is well to plan to give the bath at about the 
same time if possible each day. This should always 
be before rather than after feeding; and preferably 
before, because the child can be put to the breast 
immediately after the bath. 

Before taking the baby from his bed everything 
Every- needed for the bath should be collected and put in 
essafy n fo C r P lace - The basket holds the needles and thread, the 
the bath p Uls anc [ t ne bands, tightly rolled, and it may stand 
hand on a table or chair near the bath-tub. 

The powder and the cup containing a tepid boric 
solution should be at hand, with the soap, face .cloth, 
and towel. The bath-tub need not be full, as that 
makes it very heavy to lift, and there is no advantage 
in a quantity of water for a baby who is presumably 
clean. 



MOTHER AND CHILD 251 

The clean clothing may conveniently hang over 
the back of the rocking-chair that one sits in, if it The cioth- 
has a post or projection at one side. If not, #iey eafyreach 
should be within easy reach on a towel-rack or chair, 
and should be placed with the gown and petticoat 
underneath, then the shirt and diaper, and the band 
on top, in the order they will be needed. 

It is well to have an extra blanket or flannel The 
square kept especially for bathing, or one can use fla " n 1 ^ 1 
a flannel apron, which is particularly convenient after 
the baby begins taking tub baths. 

For the first days he will have a simple sponging, 
and we must remember in giving it that he is not a simple 

11 1111 sponging in 

used to the temperature of the cold world, but that the baby's 
he has been kept at 98.8 F. for the nine months first days 
preceding his birth, and we must protect him very 
carefully from draughts. The temperature of the room 
should be 75 ° and that of the water about ioo° F. 
The latter can be fairly tested with the bared elbow. 

In holding the baby the chair must be low, be- How to 
cause the feet should be placed firmly on the ground, hold the 
with the knees together, letting the baby's head and {^uSin^ 16 
shoulders lie firmly on the lap. him 

It does not matter if the child's legs are not sup- 
ported, but he can be much more comfortably held 
if the lap is firm and flat. If the knees separate he 
will go into the hollow between them and can not be 
as easily handled. 

Placing him then in this position on the bath 
blanket, remove the clothing, rolling him gently from Roil 
side to side to unfasten the little garments. The Hf t ier 
shock to a baby, and in fact to an adult as well, is dressing"* 
much less if he is rolled than if he is lifted bodily. the bab y 

. or patient 

The dress and petticoat are unfastened and taken off 
together, down over the feet. After the shirt is off 



252 



MOTHERHOOD 



Don't dab 
at the 
baby, but 
wash 
sensibly 



Washing 
the upper 
parts of 
his body 



Washing 
the trunk 
and legs 



one corner of the blanket should be thrown over him, 
to protect him as much as possible while the band 
and diaper are removed. A diaper should always 
be laid underneath during the bath so that the bath 
blanket or apron may not be soiled and wet. Then 
he should be snugly wrapped and his face washed 
with the clear water. 

A baby should never be dabbled at as if he were 
breakable china. Take the damp cloth firmly over 
the hand, and wash his face as you would your own. 
In drying any portion of his tx)dy the- skin should 
be patted rather than rubbed with the towel, for it 
is very delicate and a baby resents any approach to 
rough usage. After the face is washed and dried 
the water should be made soapy. Do not rub the 
soap directly on the cloth, for in that way you Use 
more on his skin than is at all necessary. 

The head, neck, and ears should now be washed, 
rinsed, and dried, and this must be carefully done, 
because the thatch of down over the little head re- 
tains the dampness longer than other parts of the 
body. Next come the arms, one uncovered at a time, 
keeping the chest and the rest of the body wrapped 
in the blanket all the while. 

Now with the left hand hold the edge of the 
blanket up a bit away from his body, so that he is 
entirely covered and protected, but so that there is 
also a space between him and the covering. With 
the cloth you can then wash the entire body without 
letting the air strike directly .on it. Turning him 
over directly on his stomach, a position which a baby 
almost invariably enjoys, wash the back in the same 
way. The legs can be exposed, as the arms were, 
for they are generally being exercised so rapidly 
that they will not feel the cooler temperature. 



MOTHER AND CHILD 263 

Care must be taken to wash off all traces of 
powder, and to cleanse carefully all the creases of 
the body, just as was done with the oil in the first 
bath. 

THE CORD-DRESSING 

If the doctor is paying daily visits, and there is 
not a graduate nurse in charge, the bandage and D ° not 
cord-dressing should not be disturbed unless the bandage 
doctor's orders have been given concerning it. In , v " th out 
that case the routine of the bath is the same except orders 
that no bathing can be done under the band. 

If the doctor is not coming regularly, and wishes 
the cord dressed or the bandage changed, great care Most 
must be taken. The dressing will not need to come t^eTtment 
off unless it is moist. In that case it must be re- dre^lng^ 
placed by a fresh piece of sterilized cotton or linen, 
and no ointment or solution should be used on it. 

If there is no person in authority to consult, and 
the cord seems to be discharging, or if the odor from 
it is very offensive, a little boracic acid powder will 
probably dry it up and is the safest treatment that 
can be given. 

The question of powder is one on which persons 
disagree, but we may strike a happy mean and use Moderate 
it moderately. While the baby is lying on his stom- p^der 
ach draw the puff across his neck and down his back, 
following it with the hand, so that there is no ap- 
parent trace of the powder left on the body. "When 
the puff is used under his arms protect his face with 
the hand, the back of it placed against his chin. 

ORDER OF DRESSING 

Now put on the shirt — we are assuming that the 
band has been left on. Put your fingers up through 



254 



MOTHERHOOD 



To put on 
the baby's 
shirt 



the sleeves, and pull the baby's hand through, first 
slipping in the arm furthest from you, then turning 
him over and drawing the shirt under him. 

Never try to push a child's or an invalid's hand 
through a long sleeve. Either put your hand through 
to meet his or gather it up into small compass, with 
the fingers through the opening. After trying both 
ways it will be easy to understand the prohibition. 

Place the diaper under the buttocks before using 
the powder, which must not be put on in excess. It 




The Flannel Petticoat and Dress 



Putting 
on the 
diaper 



only cakes in the groins and irritates more than it 
soothes. After using the puff, rub the hand over the 
thighs and buttocks to brush away any superfluous 
powder. A very good way to put on a diaper is 
to turn down the upper edge of the triangle — the 
part that lies under the baby — about two inches, so 
that it will be double at the baby's back. Bring the 
ends around and grasp the edges between the thumb 
and middle finger. Now twist the ends lightly, put 
them between the legs, and bring up the point of the 



MOTHER AND CHILD 



255 



triangle to fasten. Turn the hand holding the diaper, 
and put the pin in so that it comes out on the side 
where the middle finger is, and not against the baby's 
flesh. The diaper can be held as tightly as necessary, about the 
and there is no danger of pricking the child. Care pm 
must be taken, however, not to pin it too tight, since 



Care 




Slipping on the Flannel Petticoat and Dress 



diapers which bind a baby closely are often respon- 
sible for nausea. Xow turn him over and fold up 
the doubled portion. A diaper well put on in this 
way will never become loosened or drop off. 

Slip the flannel petticoat inside the dress and put 
them on together over the feet, not over the head. 



256 



MOTHERHOOD 



To put 
on the 
flannel 
petticoat 
and dress 



In this way the baby needs to be moved less, and is 
spared the irritation of having his face covered as 
the clothes slip down. Put your right hand through 
the dress from the bottom, and slip it up under the 
baby's buttocks-. Therewith the left hand the skirts 
may be drawn up into place, and the baby rolled 
over on his stomach while the necks are fastened. 



Washing 
the baby's 
mouth 



Bathing 
the baby's 
eyes 



Three 
rules to 
follow 



CARE OF EYES, NOSE, MOUTH, BREAST 

The boracic solution, half a teaspoon to a full 
glass of water, is already prepared with small bits 
of absorbent cotton or squares of soft cloth at hand. 

Twist a bit of the wet cotton on the fingers and 
wash carefully but very gently the inside of the 
baby's mouth. It is necessary to do this at least 
twice a day to remove particles of milk that might 
decompose if allowed to remain there, and cause 
disease. There has been some discussion of late 
years over the desirability of washing a baby's mouth, 
after each feeding, and many physicians now believe 
that such frequent cleansing . often irritates the ten- 
der lining of the mouth. 

The eyes should be bathed every morning, or as 
often as there is any sign of discharge. Taking a 
bit of cotton between the fingers, allow the solution 
to trickle over the lid, and unless there is marked 
inflammation it may be gently drawn across the eye 
from the nose toward the outer angle. Throw that 
bit of cotton aside and repeat the same process with 
a fresh piece. 

Never dip the cloth that you have used back into 
the solution. Never use the same piece of cotton 
on both eyes. Never allow the solution to flow from 
one eye to the other, as any inflammatory condition 
is directly communicable. 



MOTHER AND CHILD 257 

The nose often becomes stopped with mucus, Cleansing 
which makes the respiration difficult, tends to bring and precau- 
on mouth-breathing, which is always to be guarded VhaYtime 
against, and sometimes interferes seriously with the 
nursing. A small bit of the absorbent cotton, dipped 
in a boric solution, and twisted dry can be inserted 
up into each nostril, and will clear the nose without 
any discomfort to the child. 

If the mucus has hardened, vaseline or oil can be 
applied in the same fashion, or on a cotton swab on 
a toothpick. If the pick is used care must be taken 
not to insert it too far, and not to press it against 
the delicate membrane in the nose. 

Sometimes the breasts of a new-born baby, of 
either sex^ become distended and slightly inflamed, Treatment 
and if pressed a thin fluid will exude from the nipples, baby's 
Squeezing out this fluid must never be allozved, as breasts 
it only increases the inflammation and may easily 
produce abscesses. 

The trouble usually will right itself within a very 
few days, but if it is persistent a close bandage ap- 
plied with perfectly even pressure will be of help. It 
is better that a physician or nurse should at least Caution 
superintend the bandaging, because uneven pressure ing 
will do more harm than good. The inflammation is 
not a condition that need cause any alarm unless 
it is unwisely treated. 

TUB BATHS 

As soon as the cord comes off, the tub bath may 
be given. The baby is undressed as for the sponge when the 
bath, and is wrapped in the bath blanket. While ^nhis 
he is thus covered his face and head are washed and tub bath 
dried, and the water is made soapy. Now put the 
left hand under his head, take the feet between the 



258 MOTHERHOOD 

fingers of the right hand and let him down into the 
water. There should not be enough in the tub to 
cover the body, since the navel may not be entirely 
healed and dry. 

Supporting the head in the hand, bathe the body, 

How the arms, and legs with the cloth. Avoid trickling the 

shouidbe water over the body, but bathe the parts in order, 

first ears, neck and chest, next the left arm, then the 




Placing Baby in the Bath 

right, changing the cloth from side to side by carry- 
ing it down by the feet, rather than across the chest; 
last wash the legs, thighs, and buttocks. 

Now spread the towel across the knees over the 
blanket or woolen apron and, taking the baby up by 
the feet and head, lay him down and instantly wrap 
him up in the two, patting him gently all over. In 
this way he is kept quite warm, and is pretty thor- 
oughly dried. After the patting he can be rolled 
from side to side while the towel is taken out, and 



MOTHER AND CHILD 259 

a little extra drying can be done under the arms and 
in the groins. 

THE BAND 

The application of the band has not been de- 
scribed, and practice is certainly more necessary than 
written directions are. 

The band should be rolled closely and held in the 
right hand. Put the roll down on the right side of Putting on 

& ° the band 

the baby's abdomen and unroll the band away from 
you, holding the left hand over the loose end till the 
roll is slipped under the baby and brought up on the 
right side. 

Now hold the edges of the bandage between the 
middle and the fourth fingers of each hand, and with 
the thumb and index finger push the rolled end 
around the body once more. After it is firmly over 
the end it need be held no longer, and the remainder Fastening 
of the strip is unrolled and fastened at the end with needle and 
needle and thread. This method obviates the use thread 
of safety-pins, which make a bulkier fastening, and 
it is really very simple if the thread and needle are 
always at hand. 

The band should not be put on very tight, as the 
little bones are compressible and may easily be forced The band 

r 1 • • 1 r • / • ,.<• Should 

out of shape, causing serious deformity later in life, not be 
Besides this, the pressure from a tight band or diaper very tl§ * 
may cause vomiting. 

The flannel bandage is necessary only while a 
dressing is kept over the cord, but the bowels need , The , 

f r ' knitted 

protection and the knitted band, like a little sleeveless band 
shirt, may be substituted. In summer it may save 
the baby from attacks of summer complaint, which 
are commonly brought on by a cold, and in winter 
the added warmth over a very sensitive part is 
equally essential. 



260 MOTHERHOOD 

As long as the navel discharges or is at all moist, 
The little the little flat piece of sterilized cotton or muslin must 
sterilized be laid over it before the band is put on. The ap- 
cotton plication of boracic acid powder will tend to dry it. 

FEEDING 

After the baby's toilet is complete he should be 
put at the breast, before he is allowed to fall asleep. 
The feedings should be given with absolute regu- 
larity from the first. A child does not particularly 
J he ,. need food for the first twentv-four hours after birth, 

feedings ' ' 

the day but it is well to put it to the breast about six hours 

after birth . ,_, , * . . .,, 

after. The breasts do not begin to secrete milk in 
any abundance until the third day, but they contain 
a fluid which acts on the child as a laxative, clearing 
the bowels of the tarry substance which fills them. 
The act of nursing also tends to make the uterus 
contract more firmly. 

For the first day the baby may feed every four 

Regular hours. After that feedings should be given every 

feed?ng° r tw0 hours, beginning at half-past six, and the last 

feeding being given at' half-past ten, leaving the 

night for both mother and baby to sleep. 

He should remain at the breast for twenty min- 

Forming utes, and should be kept awake for that time, and 

beneficial made to nurse. This is often a Herculean labor, but 

andchiS if persisted in the habit will be formed and both 

mother and child will feel the benefit of it. 

The stomach of a baby, like that of a grown per- 
Howto son should have its periods of rest and of work, and 

impair the 



baby's if he is kept at the breast and allowed to nurse for 

aSgain a few moments till he falls asleep, then to wake and 

nights" 1 nurse again for hours at a time, the chances for an 

impaired digestion and consequent ill-temper, colic, 

and wakeful nights are almost assured. 



MOTHER AND CHILD 261 

A healthy baby should sleep twenty hours out 
of the twenty-four, and if he is treated fairly his 
crying will be only a means of communicating his 
needs to the outside world, and will- cease when those 
needs are attended to. 

The training of a baby will be discussed later, but The more 

... , r 1 • 1 1 1 i ust an d 

this point can not be too often emphasized, that the rational 
more rational the methods, the more they appeal to |£g oTa"' 
good sense and justice, the more likely they are to^y* 1 * 5 

J j j more bene- 

be properly hygienic and to make for the vigor and ficiai they 
joy of healthy childhood. welfare 



VI 



ABORTION AND PREMATURE BIRTH 

Abortion— Premature Birth— Care of Premature Baby— Gavage and Lavage 
—Suppressing Milk— Milk-leg— Inexorable Laws of Nature 

THE discharge of the fetus during the first six 
months of pregnancy is called abortion, or mis- 
carriage; during the last three, it is known as prema- 
of abortion ture labor. The term abortion is often misunderstood, 
because its meaning has been commonly limited to the 
inducing of labor by illegitimate means. In cases of 
abortion, the life of the child can not be maintained — 
it is not viable, in technical phraseology. 

In premature labor, it is only excessive care and 

determination on the part of those nursing him that the 

fureSt baby is kept alive, though within a few months he may 

gain enough to seem like a full-term child, and may 

have a full and early development in every way. 

ABORTION 

There are many conditions that may be responsible 

for abortion. If the uterus is diseased, or displaced 

in any way, it is very difficult to carry a child for the 

nine months. If the temperature of the mother is 

illnesses of raised, and the fever continues for any length of time, 

the mother, t j ie f e t U s generally dies within the uterus, and this 

mechanical & J - 

or emo- brings on abortion. Acute kidney disease or a depleted 
violence condition of the blood may be the causes. Long- 
continued and persistent nausea causes miscarriage, 
and alcoholism or lack of vigor on the part of the 
father may occasion it. Mechanical violence, such as 
(262) 



ABORTION 263 

blows, or sudden shock, or emotional violence, worry, 
sudden grief, or fear, are often exciting causes. 

If abortion occurs once, it is extremely liable to be a weakness 

• e 1 1 liable to 

repeated, and a habit is very easily formed, so that it repeat 
becomes difficult for a woman who has had this ex- ltself 
perience to bring forth a living chfld. 

The majority of miscarriages occur during the 
second or third month, so that in cases where it is an- 
ticipated especial care must be taken at that time. It 
is liable to take place at about the menstrual period, 
and sometimes it may be avoided if the patient lies in 
bed for a few days each month. 

Abortion is really a more serious condition than 
normal childbirth, not so much with regard to the Dangers 
chances of life as to the effect on the general health ^Sto' 
and on the condition of the uterus. It must be re- greater 
garded as a disease, and Nature does not stand ready ordinary 
to set at work upon immediate repairs and readjust- 
ments as she does when a pregnancy runs its entire 
course. As in any disease, she is the physician's chief 
assistant, and supplements any efforts of his to bring" 
the system back into healthy condition, and often with- 
out his direction she overcomes the difficulty. But the 
dangers of complication are far greater than in child- 
birth. 

The first indication that abortion is threatening is 
generally the appearance of a bloody discharge, with The first 
pain through the back and abdomen. This should be tbat Ca 
the signal for the patient to go to bed, and she should threatening 
remain there, lying on her back as quietly as possible. 
The diet should be restricted to fluids, and nothing 
hot should be given. A doctor should always be con- 
sulted, since quieting drugs can be prescribed, which 
may aid in checking the contraction of the uterus. 

Sometimes, with care and absolute rest, a patient 



264 MOTHERHOOD 

Care and can be carried through till the full term of pregnancy 
rest is accomplished. It means, however, absolute obedi- 

ence to laws prescribed by the' physician, and rest, even 
beyond what necessity seems to demand. Even then 
it is often impossible to control the flowing, and abor^ 
tion occurs in spite of the utmost care. 

If it takes place after the third month, there are 
likely to be feelings of chilliness, loss of appetite, and 
nervousness, which may precede by several days the 
flowing and the pain. 

All the discharges should be carefully observed, 
Forms the because early in the course of pregnancy the ovum 
abortion would look like hardly more than a blood-clot. It may 
mayta e ^ discharged with its membranes entire, which is 
more general during the first three months, or it may 
take the course of a normal birth, the sac of waters 
being ruptured first. In the first case, the hemorrhage 
will be slight, and there will probably be little attendant 
illness. The later abortion occurs the more it resem- 
bles a full-term delivery, and the more difficulties arise 
in its treatment. 

Hemorrhage and blood-poisoning are the chief dan- 
gers in abortion. 

When the profuse flowing starts without warning, 
The the doctor should be summoned at once. The patient 

hemorrhage should lie flat on her back, without even a pillow under 
her head. The hips may be raised on a cushion, pro- 
tected by rubber sheeting, and the foot of the bed may 
be elevated on a chair. She should never be given hot 
drinks or alcoholic stimulants, but she may take plenty 
. of cold water or milk. The room must be kept coo. 
and the recumbent position must be absolutely main- 
tained, and no exertion should, be allowed. Above all, 
the feeling of alarm should be concealed as much as 
possible from the patient. A very little blood makes a 



ABORTION 265 

very large stain, and a surprising amount can be lost 
without fatal consequences. 

If these directions are carried out, and a doctor is 
called at once, there is no need of excitement and ago- Quiet a 
nized alarm. Quiet is a safeguard, and a reliable physi- 
cian will know how to act promptly and effectively, so 
that the danger will soon be over. 

Blood-poisoning is. caused by the retention in the 
uterus of the "membranes," as they are called, — that The 
is, the placenta, and the sac in which the child is car- bfoTcT ° 
ried. The uterus tends to contract after the expulsion P° lsomn € 
of the fetus, and may close about these membranes, 
or a portion of them, instead of expelling them entire, 
as is general in normal childbirth. 

As soon as the placenta becomes detached from the 
uterine wall decomposition takes place, and the sys- The cause 
tern soon feels the effect of the poison. It is for this poisoning 
reason that a doctor should be given the charge of 
such a case from the first. He will then make sure 
that the uterus is quite empty, and will order treat- 
ment to check the hemorrhage, and to prevent the 
possibility of the poison's being carried through 
the system. 

The douche ordered in cases of confinement is a 
sprav of water carried up into the vagina, and this The vaginal 

• 11 r 1 -r r 1 . • louche 

is generally necessary after abortion. If this spray is 
sent into the uterus itself, the physician always gives 
it, and he has special instruments for it, but often he 
wishes the patient to have a simple vaginal douche each 
day, and a member of the family may be responsible 
for its administration. 

A perfectly new fountain syringe, and a glass-point 
having three outlet holes, should be used. The tern- To test 
perature of the water should not be tested by putting ItureTf^" 
the hand into the vessel containing it. A bath ther- the water 



12 



Vol. 3 



266 MOTHERHOOD 

mometer can be used if the solution is a disinfectant, 

and if plain boiled water is required, it is very possible 

after a little experience to test the temperature quite 

accurately, by pouring it over the arm. The douche- 

steriiizing point should be boiled before using, and should be 

douche placed in the syringe tube just before the douche is 

pomi given, and should not be allowed to come in contact 

with clothing, utensils, or any part of the body, before 

it is inserted. 

The hands of the attendant should be thoroughly 

Thorough washed before giving the douche or the bed-pan, or be- 

of hands fore changing the pads or bathing the breasts. All 

this applies equally in cases of abortion and of normal 

•confinement. 

Douching should not be given without a physi- 
Nodouch- cian's orders. In many cases, Nature would remedy 

ing without .,.„.,. • <• 1 c i • • • 1 

physician's difficulties if she were left alone, and it is certainly 
possible that a continual use of the douche may tend 
to weaken the muscles and ligaments and to debilitate 
the tissues. It is better to be too conservative in this 
matter than to run the risks of making improper and 
too frequent use of the douche. After menstruation, 
it is entirely superfluous, for the process is a normal 
one, which calls for no artificial treatment beyond the 
simple external bathing which ordinary habits of clean- 
liness would suggest. 

After a miscarriage, the same care should be given 
Care and as is required after childbirth — as far as keeping the 
fordelnH S patient in bed, and taking precautions regarding clean- 
eflVof liness. But more than this, it must be remembered 

Sa.ITlc 3.S 

a , f * e r . , that the shock to the nervous system has been extreme, 

childbirth , , , J t , . , . ' 

and that there is liable to be mental depression, which 
can be overcome only by great patience and by the 
speedy return to physical well-being. Often, when the 
birth of a child has been anticipated with great joy, 



PREMATURE BIRTH 267 

the sorrow of loss is felt all the more keenly, because 
the little life went out almost before it was given ; and 
the fact that the consciousness of motherhood does not 
follow, and crown the trial of pain and illness, is often 
never expressed, perhaps because it is felt so intensely. 
All this only goes to show how 'nursing in cases 
of miscarriage should differ from that after normal Care and 

. . sympathy 

deliver} 7 . Here the mother's mind is so filled with in- with the 
terests outside herself that her own ailments gain little mental S 
attention, and nervous and mental disorders seldom state 
need be reckoned with. After abortion, on the con- 
trary, when the first danger is past, the mental state 
overshadows and governs the physical, and the cour- 
age and poise of the woman depend largely on the 
patience, tact, cheefulness, and versatility of those 
about her. 

The period in bed will depend upon the condition 

of the patient, both physical and nervous. Sometimes The P eriod 

11-. 111 • in bed 

when the depression is very marked and persistent, a 

doctor may allow her to get out of bed, in the hope that 
her interest will be roused. Ordinarily, however, it 
depends, as in the normal case, upon the state of the 
uterus — its position and the completeness of its con- 
traction — and on the amount and character of the dis- 
charge. 

PREMATURE BIRTH 

During the last two months of pregnancy, a child is 
said to be viable ; that is, it is possible to keep it alive Care of 
outside the uterus. At the seventh month, the child is seventh- 
perfectly formed, the eyes are open, and the nails are ™^ h 
present. The weight is between three and four pounds. 
The chief difficulty here is the care of the child — to 
keep it in an even temperature, to give it proper and 
sufficient nourishment, in fact to reproduce artificially 



268 



MOTHERHOOD 



How the 

incubator 

works 



Home 
substitutes 
for the 
incubator 



How to 

make the 
baby's 
cotton 
suit 



some of the conditions of its life within the uterus, 
which should have been prolonged. 

In the hospital, of course, the incubator is used. 
The heat supply is regulated so that it may always be 
the same, and hot water is the medium through which 
it is conducted, so that the lungs are given a proper 
amount of moisture. The baby lies in a chamber in- 
closed in glass so that he can be watched without being 
removed, and the air is kept at the desired temperature 
by artificial heat. 

In the home, incubators are generally out of the 
question, but there are various substitutes which can 
provide approximate conditions. 

There should be no attempt to dress the baby in 
the regulation shirt, petticoat, and dress, beca.use rest 
is one requisite to his welfare. A cotton suit can be 
easily made of cheesecloth, padded with lambs' wool 
or absorbent cotton. Cut out double thicknesses of 
cheesecloth and cotton in the shape of a Greek cross, 



o 



one having four equal arms. Bring opposite arms 
together, the cotton being laid between the cheese- 
cloth, and the edges turned in, and sew over and over, 
all around, except at the ends of the arms of the cross. 
Now cut out a round hole in the centre of the fold, and 
a slit down from this hole to the lower edge. Finish 



PREMATURE BIRTH 269 

the raw edge, and you have a cosey little jacket, which 
ma>- be sewed on and will keep the child much warmer 
than the ordinary oarments. 



\jy 



Little bootees are made in the same way, using 
stockings for patterns. These are pinned to the edge The other 
of the jacket, or to the diaper. The little band and garments 
diaper are the only other garments necessary. The 
temperature should be kept as nearly uniform as pos- Necessary 
sible, and as high as eighty-eight or ninety degrees. Mature" 
Any device which makes this possible may be used. 

A bed made in a clothes-basket and kept near a 
fire, with a hot-water bag: on either side of the baby, P s< : of 

° J ' basket or 

answers the purpose. Two tin tubs, put together after tin tubs 
the fashion of a double-boiler, with hot water in the 
lower one, is another arrangement which has proved 
a successful substitute for an incubator. A lamp 
placed underneath the tubs keeps the water hot, and 
the pillow on which the baby lies in the inner tub pro- 
tects him from the direct heat of the metal. 

CARE OF THE PREMATURE BABY 

A premature baby should be disturbed as little 
as possible. Xo attempt should be made at bathing, Oiling 
but each day he should be oiled with sweet-oil, being changing 
kept carefully covered during the process, and a 
fresh cotton jacket should be put on every second 
day. The diaper should be changed as often as 
necessary, and the child kept absolutely clean. 

This can be done without taking him from the 



270 



MOTHERHOOD 



bed, and in fact he need be lifted very little. He will 
Disturbing have to lie on the nurse's lap for his oil bath, but 
as little as all the changing can be done without disturbing him, 
possible an( j un i ess he. nurses his feeding can be given him in 

his bed. 

Some premature babies nurse with much strength, 

but more often they must be fed. If the mother's 




Feeder for Premature Baby 



milk comes into the breasts it should be pumped out 
and given the child either with a teaspoon or a 
medicine dropper. 



Forced 
feeding a 
simple 
process 



Method 
to use 



GAVAGE AND LAVAGE 

Sometimes forced feeding through a stomach 
tube must be resorted to. This is called gavage, and 
should be done under the direction of a physician 
until the method is understood. It is really a very 
simple process, may be accomplished without dis- 
turbing the child, and will take a very short time if 
skilfully done. The apparatus consists of a small 
soft rubber catheter attached to a glass funnel. 

In giving the feedings the tongue is depressed 
with the finger, and the tube, moistened with oil or 
with water, is introduced quickly down the gullet 
into the stomach. Two or three inches is far enough. 
The funnel is then held up to allow the escape of 
gases ; after which the milk is poured in and the tube 
quickly withdrawn. If this is rapidly done, there 
will be no vomiting. 



PREMATURE BIRTH 271 

Lavage, or washing the stomach, is generally Method 
necessary once a clay. It should be done with boiled ° 
water. 

The tube is introduced in the same way, and 
about a tablespoon of water poured in. Before 
it all disappears the funnel is lowered and the fluid 
is drawn off. The process is repeated till the water 
returns clear. If the finger is kept in the corner of 
the mouth for a few seconds after the tube is drawn 
out, vomiting is less liable to occur. 

The tube and funnel should be washed carefully 
in water containing a small quantity of baking soda. Absolute 
The cleanliness of this apparatus is extremely im- arequSiS 
portant, because the lining of the stomach is so deli- 
cate that if any impurities were carried into it an in- 
flammation would be likely to set in. The tube and 
funnel should be occasionally boiled. 

In caring for a premature baby one of the essen- 
tials is the belief and determination that he shall be Determi- 
kept alive. If warmth, nourishment, and rest can keep the 
be kept up, the chances are good ; but it is impossible \^J e an 
to give proper care if the ultimate death of the child essential 
is believed to be a foregone conclusion. It is a diffi- 
cult matter, and even with constant care, patience, 
and watchfulness it may be many months before the 
anxiety is removed, and the baby can be treated like 
a normal child. 

SUPPRESSING MILK 

In cases where the child is dead at birth, or dies 
soon after, there is likely to be trouble with the When . 

J m t precautions 

breasts unless precautions are immediately taken, should 
The glands do not begin the secretion of milk until 
the second or third day, so that if the baby is still- 
born the treatment may begin at once. It is the 



272 



MOTHERHOOD 



Putting 
on the 
Murphy 
bandage 



same in any case, except that before the milk is in 
the breasts they are less tender. 

If the breasts are dusted with boracic acid pow- 
der, non-absorbent cotton laid between them, and a 
close bandage is put on so that even pressure is ap- 
plied, there will be no danger of an accumulation 
of caked milk and subsequent abscess. 

The most satisfactory bandage is the "Murphy," 
which is shaped to fit about the neck, and is cut out 
under the arms. This should be pinned in front on 




The Murphy Bandage 



Its effec- 
tiveness 
and use 



a straight fold from a point about half-way from 
the neck to the lower edge. Above this it may be 
turned in and made very close. 

Below the middle pin on either side darts must 
be taken in, and the bandage thus drawn as tight 
as possible. The pieces over the shoulders are to be 
pinned last. 

, When the milk comes in, the bandage will, of 
course, feel uncomfortably tight, but this can be en- 
dured for forty-eight hours, when the pressure will 
begin to subside and the difficulty will be over. The 
bandage should be kept on for some time until all 
danger of further secretion of milk is past. If this 
method is used there is no need of external applica- 
tions such as rubbing with ointments or painting 



PREMATURE BIRTH 273 

with iodine. If the bandage cuts the flesh about the 
arms non-absorbent cotton can be laid under the 
edge of the arm's eye. 

If suppression of the milk is necessary after it has 
come into the glands, the same treatment is effective, When 
but it is likely to be rather more painful, because of come into 
the pressure applied directly on the already distended the glands 
breasts. It is, however, certainly the simplest method, 
although the various applications may be used with 
success, and with no complications. 

If the bowels are kept freely open with salts, and 
fluid diet is restricted, the milk will come into the 
breasts less freely. 

MILK-LEG 

Since abortion represents an abnormal condition, 
we have included under it some of the diseases which 
sometimes complicate the pregnant state. 

Difficulties with the breasts may arise after a full- 
term confinement, and the condition known as milk- 
leg has no particular association with abortion, though 
it has place in this chapter. This trouble received its 
name because it was ignorantly supposed that it was 
caused by an actual accumulation of milk in the leg. 

It is a condition occasioned by a clot of blood which 
is formed in one of the veins. The presence of the clot How 
causes inflammation of the vein, which gives it one of isocca- 
its various names — phlebitis. The local inflammation S10ne 
has a still more remote cause, which is now generally 
believed to be a mild infection from some micro- 
organism. 

It may follow unusual difficult labor, or sometimes 
occurs after operation or after abortion, particularly 
if the membranes have been retained within the uterus. 
It generally begins within two or three weeks after 



274 MOTHERHOOD 

labor. The pain is usually localized at first, either in 
The symp- the hip or ankle, but soon extends. There is often 
miik-ieg a chill, followed by fever, and the lochia, or discharges 
from the uterus, begin to have an offensive odor. 

In a very short time, the leg commences to swell, 
and the power in it is almost entirely lost, while the 
pain is extremely acute. It is generally not a danger- 
ous condition, but it is a very stubborn one, for even 
after apparent recovery there is a tendency to a re- 
currence of the swelling for weeks or even months. 
The leg should be given entire rest, should be el- 
Treatment evated on pillows, and moist heat should be applied, 
t/oubfe Compresses of flannel, wrung out of a solution of 
witch-hazel and water in equal parts, applied as hot 
as the patient can bear it, are very effective. 

Gentle rubbing was formerly recommended to pro- 
No rub- duce absorption of the clot, but that is a dangerous 
friction process and should always be avoided. If the clot 
is dislodged by the friction, it may pass along the 
vein to a locality where it may do still more harm. 
Local applications to promote its absorption may be 
suggested by a physician, but anything like massage is 
not advisable. The rest and the elevation of the leg 
should be continued until the trouble is entirely cor- 
rected, and a close bandage or elastic stocking is use- 
ful when the patient begins to walk, to prevent the 
swelling which is inclined to reappear. 

INEXORABLE LAWS OF NATURE 

Abortion produced by medicines, which bring about 

The moral contractions of the uterus, or by instruments, ranks 

cance of of course with malpractice when a physician is rer 

abortion^ sponsible' for it. The moral significance of the act 

seems to make little impression upon the number of 

women who refuse to accept child-bearing; but they 



PREMATURE BIRTH 275 

must realize in time Nature's inevitable retaliation for 
violation of her laws in the weakening of physical 
vigor and nervous force. There is always the ques- 
tion which is the greater sin, to bring a child into the 
world — to force upon him a life which must of ne- 
cessity be starved and cramped — a possibility which 
gives malpractice its opportunity — or to crush out 
that life almost at its conception. Of course, the sin 
goes further back than this, to the rights of parents to 
take the responsibilities of child-bearing, unless they 
are willing to make good — to give to their children the 
chance to choose what they will do with their lives. 

A child ought to be assured of the right to child- 
hood, free, untrammeled, with sunshine, fresh air, and T , he ri £ ht 

of every 

loving care ; he ought to have the promise of food, child 

shelter, and clothing, reasonable health and education 

enough to fit him for the work of life. 

But with Nature, this question of the greater sin 

seems not to be considered. Her laws are disobeyed 

when the life once begun is interrupted, and she metes 

out her punishment inexorably. The penalty is abso- 
t 1 x r i f e i ■ • A" abso- 

lutely sure. If the functions of the generative organs luteiy sure 

are interfered with, weakness, if not disease, results, pena ty 
and a woman becomes nervously broken down, more 
surely than if she had gone through the period of preg- 
nancy and childbirth. 



VII 



HABITS ARE METHODS OF TRAINING 

Law of Habit— Unwise Training— The Day's Routine— The Baby's Laundry 
—Details of Bath— Naps— The Outing 



What the 
baby 
does not 
"already 
know" 



Making 

good 

habits 



W 



LAW OF HABIT 

E often hear mothers say that the baby of two 
weeks "already knows" that he can force her 
to indulge him, that he can make her walk the floor 
with him, or nurse him whenever he cries. Perhaps 
if she understood better just what that seeming keen- 
ness of knowledge is, she would be more willing to en- 
dure the little vexations of the moment for the sake 
of the added comfort of the years. It is not dawning 
intelligence that makes the baby cry till he is taken 
up, and stop when he is soothed in the mother's arms, 
or borne about over a comfortable shoulder. It is sim- 
ply that law of our nature which has caused most of 
our oft-repeated acts to grow mechanical, which makes 
it possible to carry on the daily occupations, like dress- 
ing ourselves, eating our meals, and going to our 
work, without being obliged to concentrate our minds 
upon them. 

Habits are formed before there can be conscious 

thought, and habits that help the child and the mother 

are as easily established as those that make the baby 

permanent a tyrant in the home. Each time an act is performed, 

the chain of associations js made a little stronger, and 

under the same conditions the same result is more likely 

to be reached. It may take many trials to make per- 

• manent some of the habits that one is working for, 

(276) 



HABITS 277 

especially if the baby is not perfectly normal in health, 
but mothers as well as nurses have proved that it can 
be done. 

Mothers who have come under the influence of our 
grandmothers' theories concerning the "bringing up" The old 
of children, sometimes feel that the modern idea that i ng up 
we should help Nature by supplying fresh air, sun-^new 
shine, good food, and plenty of sleep, and after that- 
let the child come up rather than be brought up, indi- 
cates a heartless classing of the human young with the 
"beasts of the field." To such a person the care of a 
baby signifies the entire absorption of a mother's time 
and strength, and often the depth of her devotion is 
measured by the extent of his tyranny. 

If she could only realize that it means a mutual 

benefit to accustom the child to lone: hours of rest to Lon s p 
i * • , * 1 1 1 , hours of 

body in sleep, and to nerves and muscles through nor- sleep and 

mal expression of his activities in natural exercise, exercise 
she would have fewer qualms of conscience in en- 
joying the added leisure it would give her. A baby 
will find endless entertainment in the free movement 
of his own limbs, if not hampered by clothing, as he 
lies in his crib, unless he has been trained to cry for the 
artificial exercise and the stimulation of constant 
change of position. 

For the first few months, sleep should make the 
largest part of his day. This can only be accomplished 
if he is kept comfortable as far as his other demands 
are concerned. Food is the chiefest, and if this is 
given when it is needed, it will take little time, and will ^eV* 
be expected only at stated intervals. Warmth is an- intervals 
other requisite, and can be realized if the temperature 
of the room is well regulated, the crib is protected from 
draughts, and the diapers are changed often enough to 
keep the dampness from the other clothing. 



278 MOTHERHOOD 

Great care should be taken to guard the baby from 
Guard the shocks to the nervous system. Fear is not yet devel- 
nervous oped, there is no reason in his sudden cry and start, 
shocks ^ ut ^ jj tt j e fo £y j s a ij ve w }t n nerves, and every time 

these are played upon uselessly they are so much more 
easily affected and less likely to perform their greater 
function. We see the results, not in added sensibility, 
but in lack of control and poise, in little reserve force, 
and often in an excessive emotionalism. 

The aim of motherhood ought to be to bring forth at 

least as good a representative of the species as either 

of the parents, and after birth to give the care which 

will bring about at least as perfect a development. The 

^""hnd amma ^ s of other species accomplish this, but the 

develop human animal fails of it time out of number, and 

Nature's too often has no sense of obligation in the matter. If 

hnes obligation is admitted, it must also be conceded that 

we could perhaps learn from the methods of animals 

in caring for their young, that the best results are not 

attained by surrounding a Child with artificialities, and 

by keeping his senses abnormally alert, but by letting 

his development progress along Nature's lines. 

The number of babies who are allowed to go 
through babyhood as little happy animals, with every 
want gratified when they are clean and warm and fed, 
is increasing every year, but there is still an appalling 
amount of ignorance and well-intentioned cruelty in 
their treatment. 

UNWISE TRAINING 

If we follow a baby brought up in the latter way 
through his day, we can see why he is a troublesome 
child, and can appreciate better, perhaps, the rational 
method of caring for him. 

In the morning, when his first day feeding is due, 



HABITS 279 

he is asleep, and the mother, thankful for a little respite, The baby's 

11 i , ..ii 11 1 • 1 • • morning 

hushes the other children and lets him he quiet as in bad 
long as he will. Stomachs only a few days old hold training 
very little, and after a long fast this one begins to make 
active remonstrance. Up comes the baby, wet and 
starving, showing such signs of indigestion that the 
mother at once gives him food in self-defence, and 
pushes on bath and clean, dry clothes for an hour or 
so longer. 

The milk is taken so rapidly, and the stomach is 
filled so full, that instead of going off to sleep, the How he 
little one fusses and cries till life is a burden to. the 
entire family. He is trotted and rocked, a rubber nip- 
ple, a "pacifier," is put in his mouth, or an attempt is 
made to nurse him again, till the process of digestion 
has corrected some of the discomfort, when he falls 
asleep. 

When he wakes again, the dampness from his wet 
diapers has penetrated through all his clothing, and His sleep 
he is either steaming or cold, and must inevitably be 
chilled when he is taken out of his nest for his next 
feeding. His bath soothes him so that he sleeps for 
some hours, and a repetition of the empty stomach and 
the cramps from greedy feeding follow. 

So the day passes with frequent periods of crying, 
with irregular feedings, with much handling and with 
discomfort on the part of both mother and baby. 
The night brings little sleep, for the feedings have been 
given at such long intervals that the night's rest is as 
broken as the day. 

The really pernicious thing about such a scheme 
for the baby's life is that it is not confined to the early Pernicious 
months. It can not help making its influence felt baftrain- 
th rough the years. The stomach will not fulfil its ^ffer'iife 
duty in after life if it is alternately starved and over- 



280 



MOTHERHOOD 



The key- 
note of 
a baby's 
existence 



The de- 
forming 
effect 
of the 
"pacifier" 



How it 
misshapes 
the mouth 



111 effect of 
breathing 
through 
the mouth 



loaded at first, and the nervous system will demand 
variation, excitement, and indulgence if these things 
are supplied in babyhood. That means that the ner- 
vous force will be exhausted, and can not be depended 
upon in time of need. 

Serenity ought to be the keynote of a baby's ex- 
istence. Through childhood, we are supposedly pre- 
paring the body to meet the requirements of adult life, 
and whatever handicaps the organism for future use- 
fulness, whatever exhausts, rather than builds up, is 
distinctly working against that end. 

Few mothers understand the really harmful effect 
of the "pacifier" or nipple, which a baby is allowed to 
keep in his mouth between his feedings. The con- 
stant use of such an apparatus is almost sure to de- 
form the jaw, which means difficulties when the teeth 
begin to come, and also a condition known as mouth- 
breathing, which may be- responsible for many ills of 
throat and lungs. If teeth are overcrowded, as they 
must be when the jaw is misshapen, they are much 
more liable to become decayed. 

It is an easy matter to pick out from a group of 
children those who have been allowed to suck empty 
nursing bottles or the regular nipple. The upper-lip 
is swollen and protruding, the under-lip recedes, and 
unless the habit has been outgrown for some time, 
the child generally drools when he has not the nipple 
in his mouth. 

When we breathe normally, through the nose, the 
air is warmed and filtered before it reaches the lungs. 
The impurities are largely sifted out in its progress 
through the nasal passages, but when it is taken in 
directly through the mouth, all the dirt and the germs 
of disease have much freer access to the lungs, so that 
the danger of infection is greatly increased. 



HABITS 281 

This ought to have weight, even if the unsightly ap- 
pearance of a child whose mouth has been so deformed 
has no influence with the mother. 

THE DAY'S ROUTINE 

There can be a routine order in the care of the 
child which becomes habitual and saves much labor. 

lie should be taken up for his first feeding at 
about half past six, and for six weeks food should be Hours for 

. feedin° r 

given every two hours, until half past ten in the even- a baby 
ing. One feeding between this hour and morning is ^" e ^ S1X 
enough. He should be allowed to nurse for twenty 
minutes, but should be kept awake and busy during 
that time. 

Generally the mother can arrange a definite time 
for the bath, and can give it at about the same hour Definite 
each day. It should come between the feedings about ti^bath 
an hour after he has nursed, and is given preferably 
in the forenoon. 

The baby should be waked during the daytime for 
his feedings. There is a temptation to let him sleep, Wake 

11 • • 1 r c r i tne baby 

but he requires a certain number ot ounces ot tood for his 
during the twenty-four hours, for the proper nour- ee ings 
ishment of his body, and it is far better for him to 
get this largely between six and ten, leaving the night 
for unbroken rest. 

The hours of his meals should be absolute. A 
baby's cry generally means something, especially if . 
he has been properly treated from birth, but it more 
often means over than under feeding, and while put- 
ting him to the breast may silence him, it does not cor- w^ter 1 "" 1 
rect the trouble, but onlv makes it more liable to occur !. hree . or 

J four times 

again. He requires water as well as milk, and should a day 
have a teaspoon of it three or four times a day. 

The crying may be caused by thirst or by colic 



282 MOTHERHOOD 

His crying pains from gas in the intestines. This latter diffi- 
culty is especially frequent when the mother is taking 
cathartics. The warm water may relieve this, or 
turning the baby over on his stomach and rubbing 
his back often sets the gas in motion and thus gets 
rid of it.. Very often holding a baby in front of a 
fire and warming his hands and feet will stop his 
crying and will relieve pain. If colic seems to recur 

for^cST* a * a k° u * the same time each day, a thorough toasting 
and rolling the child in a heated blanket will some- 
times act as an effective preventive. 

Some babies cry when the diapers are wet, and 
they should always be changed when the feedings are 
given. If wet or soiled napkins are left on the deli- 
cate skin becomes chafed and there is further cause 
for uneasiness. If the precaution of frequent chang- 

Treatment { n cr is observed there will probably be no trouble of 

for irri- ° . ........... , 

tation of this sort, though sometimes if there is diarrhoea there 
is an unavoidable irritation of the skin. 

Bathing with a solution of boracic acid tends to 
heal the chafed surface, and if stearate or oxide of 
zinc or bismuth subnitrate is used to powder the 
buttocks after the bathing the condition is quickly 
relieved. Talcum powder is all that is required 
ordinarily, but the zinc has particular properties of 
absorbing water which makes it of especial use when 
the skin needs particular care. 

Talcum powder is of equal service in the case of 
similar an adult invalid, especially when there is difficulty in 
retaining the urine or excessive perspiration, so that 
the skin in the crease between the buttocks is in- 
clined to be moist. It has no tendency to become 
caked, but it should not be put on thickly, and should 
always be washed off when the parts are dressed. 

Having then looked after the diapers, having 



treatment 
for adults 



HABITS 283 



made sure that the clothing is not creased uncom- Points to 
fortably under him, and that there are no pins un- w hen a 
clasped and pricking him, having given him water baby cnes 
and changed his position in the crib, he may safely 
be let alone and allowed to cry for a time without 
fear of injury. 

A mother soon learns to distinguish the character 
of a crv, and can also tell bv the position the child Character 

11 • 11 • T t> 1 1 ° f t,ie 

assumes whether it is caused by pam. If he draws baby's cry 
the knees up against the abdomen and holds them there position 
it generally indicates colic, while in temper he usually 
stiffens his arms and legs and makes his back rigid. 
If a child is really delicate, not normal in health, it 
may easily be impossible to follow the usual rules in 
his training, but more babies are made abnormal by 
unwise treatment than by inherited tendencies. 

We will suppose that the bath is given in the 
middle of the forenoon. The rest of the day is un- 
varied till late afternoon. 

The baby is undressed and put into his night- 
clothes just before the half-past four feeding. If the ^"is^ 
room can be made warm enough it is a very good undressed 
plan to let a baby tumble about on a big bed, dressed 
only in his diaper and shirt, for fifteen or twenty 
minutes at this time. He will enjoy the freedom, 
and after a few months he will begin to make efforts 
toward co-ordinated motion. 

He will especially enjoy lying on his stomach and 
kicking very hard against a hand held at his feet. 
Movements of this kind, the self-expression of his Baby's 
activity, are helpful in the development of the child, gymnastics 
while trotting, tossing, or walking the floor with 
him are purely pleasurable excitements which retard 
rather than increase his ability to depend on his own 
resources. 



284 



MOTHERHOOD 



Let his 
diversion 
be along 
natural 
channels 



We have 
lost the 
child's 
point of 
View 



Excess of 
toys unfits 
a child 
for the 
work of 
life 



The day's 
schedule 



A baby does not need to be amused if his interests 
are helped along natural channels instead of being 
diverted into artificial ones. When he is old enough 
to sit up in his crib or on the floor, a simple toy, or 
often investigation of his own hands and feet, will 
keep him busy and happy, and later the discovery of 
the use of his muscles is a joy the sweets of which 
we can not appreciate because we have lost it from 
our memory of babyhood delights. 

We make trouble for ourselves in our care of 
children. We take from them simple pleasures in 
the way of physical activities because we are "Olym- 
pians" and have lost the child's point of view, and we 
offer substitutes that seem desirable from our stand- 
point, which require our co-operation and which do 
not at all represent a child's original interests. 

An over-abundance of toys and of devices for 
the entertainment of the child means dissipation quite 
as surely as over-indulgence in any other variety of 
luxurious living, and the results educationally are 
almost as pernicious as those of the latter sort are 
physically. It is unfitting a child for the work of 
life. 

The day's schedule then would be as follows : At 
half-past six the baby gets his first feeding of twenty 
minutes, is changed and laid down again. At about 
half-past nine the bath is given, and he is dressed 
Clean and fresh for the third meal at half-past ten. 
The afternoon routine is unvaried, nursing him and 
keeping him dry being the rule, alternating with an 
occasional drink of water and a change of position. 
Between four and six comes the preparation for the 
night, and the little frolic on the bed. 

The body has not been disturbed by unnecessary 
handling, the nerves have not been unduly stimu- 



HABITS 285 

lated, the physical needs have been satisfied, and 
neither mother nor child is nervously wearied by the Why the 
end of the day. If the feedings have been regularly s i ee p well 
given, the dark and extra quiet will tend to make the 
baby sleep in longer intervals during the night, and 
the mother can get her much needed-rest. 

A baby needs fresh clothing each day, especially 
the bands and shirts, which come next his bodv. ci ia , n . geso£ 

' clothing 

Sometimes a slip and petticoat may be used a second 
time if they are taken off at night and carefully aired. 

THE BABY'S LAUNDRY 
The shirts are very easily laundered, and it is ad- 
visable to wash them out as they are used. If dia- Sim P ,if y- 

J ing the 

pers, shirts, and dresses accumulate it seems much laundry 
more of a task to get them out of the way, but if they 
are done each day as they are taken off it is a very 
simple matter. 

The device of putting small squares inside the 
diaper to receive discharges from the bowels makes 
more pieces to wash, but also makes the washing 
easier. As soon as the diaper is taken off, the solid 
matter on it should be rinsed off under running 
water, and the cloth should be put to soak. Absorb- 
ent cotton can be substituted for the small squares, 
and can be burned; this is an additional expense, 
though a small one. 

Soiled diapers should never be put on a second 
time, and it will take only a few moments to wash Wa s nin s 
them out as they are used. The odor becomes very diapers 
offensive if they are left, even when they are covered 
with water, and they are more objectionable to handle. 

DETAILS OF BATH AND NAPS 
The daily bath may seem like a burden, and is 
even regarded by some persons as unnecessary, but 



286 



MOTHERHOOD 



Comfort 
and 

health of 
the skin 



when the added comfort of the child is considered, 
its value must be admitted. Added to. this, the same 
reasons that are given for frequent bathing in the 
case of a grown person obtain when applied to the 
baby. It is a question of keeping the skin in healthy 
condition, and this can- be done only by cleanliness. 

Especial care should be taken to guard against 
draughts. The room should be warm and of even 




Bath Under the Blanket 



temperature, and sunny as well, if that is a possi- 
bility. There is little danger in the exposure of a 
Guard . baby's body if the surrounding air is warm, though 
dfaJTghts in for tn e first few days the bath should be given under 
bathing t h e blanket, and for several weeks the baby should 
not be long uncovered. It must be remembered that 
his mode of living has been radically changed by his 



HABITS 287 

birth, and the shock of the adjustment must be tem- 
pered as far as may be. 

When the first tub-bath is given the shock to the 
nervous system caused by the plunge into water is How to 
made much less if the child is put into the water with baby in 
a clean diaper wrapped loosely about him. It can hls tub 
easily be removed from the body and allowed to lie 
in the bottom of the tub, where it will not interfere 
in the least with the bath. 

Attention to nose, eyes, and mouth should be sys- 
tematically g^iven, even if there seems to be no Attention 

J ° ' to nose, 

especial apparent need. The boric solution strength- eyes, and 
ens the eyes, and makes them less liable to inflam- mou 
mation when the. child catches cold. Washing the 
mouth is more rather than less important as the child 
gets older, for the preservation of the teeth depends 
on cleanliness. 

If it is possible the baby should take his naps in 
a quiet, darkened room. We can not be sure what Naps 
impressions are being made on the sensitive nervous ^a"^^ 
organization, nor how much consciousness of the darkened 

room and 

noise of talking and of the presence of numbers of alone 
persons in the room exists, but we do know that 
there must be more complete relaxation when these 
conditions are not present, and that beyond this the 
habit of going off quite alone at nap-time is a valu- 
able one to establish. 

At first life is a series of naps, with incidental 
wakings for food, but later there will be, of course, 
longer periods of wakefulness and fewer hours in 
the daytime to be spent in the quiet of the nursery. 

THE OUTING 

A baby should have regular out-of-door exercise 
after the first four or five weeks. In winter the 



288 



MOTHERHOOD 



Hours to 
choose 



Dress for 
the outing 



Substitute 
for the 
outing 



Summer 
outdoor 
life 



Summer 
in the 
city and 
parks 



outing should be made in the middle of the day, 
either just before or just after noon. In the sum- 
mer early morning and late afternoon are the safest 
times. 

In winter the baby should be thoroughly warm 
before he is taken out, and should have plenty of 
thick wraps. Especial care should be taken to have 
his hands and feet warm, for it is by exposure of 
the extremities that colds are contracted. 

If the weather is too severe or stormy to risk 
the out-of-door exercise, an indoor substitute may 
be used. Dress the baby warmly, put him in his 
carriage or on the bed, and open all the windows of 
the room where he is sitting. Draughts must be 
avoided, but plenty of air must be admitted, and the 
danger of catching cold is no greater than it is out 
of doors. 

In the summer children should be kept in during 
the middle of the day. In the morning the air is 
fresh and will be good for them. In the country it 
is often possible to keep the child out for the entire 
day, but in the large cities the pavements and un- 
shaded streets become so hot that it is not only 
unpleasant but not safe to leave children out through 
the heat of the day. 

If a park or playground is accessible never keep 
the children in the streets. Let them spend their 
outing under the best possible conditions. The fresh 
air, the lack of dust, the restfulness of green grass, 
and the shade of trees are important factors which 
make for health, and the mother will be repaid two- 
fold for the little extra exertion of dressing and 
taking the journey, long or short, both by added 
serenity of temper and by comfort of body. Go 
home before the sun is too hot, and give the baby his 



HABITS 289 

bat'h, after which he ought to sleep through the mid- 
day hours. 

Do not make the mistake of keeping too many 
clothes on him. If he is kept from draughts he may The baby's 
dress very lightly in the hottest days. The abdomen in hot 
should be protected by either the flannel or knitted tolV n 
band, since the dread disease of the summer months 
is cholera infantum. If the band is worn the regular 
shirt may be discarded in the hottest weather. 
Changes in temperature must be observed, however, 
and the necessary addition in coverings must be 
promptly made. The flannel nightgown gives place 
to the cotton slip, and even the flannel skirt 1 may be 
shed for a few hours in the day when the weather 
is oppressive. 

Late in the afternoon or early in the evening, if 
it is possible to get another breath of clean air that 
has blown through the trees or from the water, in- 
stead of along dirty city streets, the night will be 
more restful because of it. 

The prejudice against night air has been pretty 
thoroughly overcome as knowledge of the principles Ni s h t 

r • 1 , • • 1 r i , r , , • , air is the 

of right living and of the needs of our bodies has only air at 

increased, but there are still many persons who are breathe 

inclined to shield the baby from the fancied ills of 

night dampness and to oppress him with the serious 

danger of exhausted air. He must not be given 

used-up air to breathe. Even more than those of 

grown-up persons must his lungs be supplied with 

oxygen to feed the blood. 

It is always the direct draught that is dangerous. 

The crib can be thoroughly protected and the baby How t0 

can be kept warm even more easily than a grown baby from 

person. It is a very good plan to have little straight raug ts 

curtains of stout muslin made to fit around the head 
i3 Vol. 3 



290 MOTHERHOOD 

of the crib, and to tie on the bars with tapes. A 
piece about eight inches in width may also be 
stretched across the top at the head, shielding the 
baby's eyes and more effectively protecting him 
from draughts of air. 

This is the simple life that best suits a baby's 
The needs. The routine of it soon makes it the easiest 

simple life - , , , , , . . . , . 

the best f rom the mother s standpoint, and if it is persisted in 
all the details become matters of habit, and their 
accomplishment less and less of an effort. 



PART III 



CARE OF CHILDREN 



INFANT FEEDING 

Mother's Milk— Weaning— Cows' Milk— Modification of Milk— Prepared 
Foods— Points to be Noted— Schedule for Feed- 
ing—Household Measures 

WE may divide the subject of feeding for chil- 
dren into three parts, following the plan sug- 
gested by Dr. Rotch. The first period would extend Three 
over the first ten or twelve months ; the second, over periods of 
the second or third years; and the third would in- "^^ 
elude the remainder of childhood. 

The first period is the most important and is the 
only one where milk supplies the entire nutrition. 

MOTHER'S MILK 

To say that mother's milk is the ideal food for a 
child states a self-evident fact. Every one knows The ideal 
that it is the natural food, and that the child thrives the baby 
on it, but sometimes it does not seem to be generally 
understood that it provides to a degree really un- 
attainable otherwise the properties that are needed 
for his growth and development. 

The most logical substitute for maternal feeding 
would seem to be the wet nurse, and in our grand- The wet 
mothers' days that was the first resort, though it nurse 
was too often a questionable good on account of lack 
of thought in the selection, the fact that a woman 
had an abundance of milk being often her only recom- 
mendation. 

The existence of disease, or indeed the negative 

(293) 



294 



CARE OF CHILDREN 



milk 



condition of poor health, or an excessively emotional 
Requisites temperament, however it may manifest itself, should 
nurse debar a woman from taking up the duties of a wet 
nurse. She should be in a thoroughly normal state, 
her confinement should have been as nearly as pos- 
sible on the same date as that of the mother en- 
gaging her, the amount of her milk should be ascer- 
tained, and if it can also be analyzed it will add an 
element of surety to the result. She should be, if 
possible, between the ages of twenty and thirty. 
The advance of scientific interest in the modifica- 
Substitutes tion of cow's milk for infant feeding and the numbers 
mother's °^ P atent foods on the market have made the em- 
ployment of wet nurses much less common than it 
once was, and because it is true that children are 
successfully nourished and become healthy and 
strong on one or another of the prepared foods, we 
are inclined to lose sight of the fact that Nature's 
provision is the economical one, and that, other things 
being equal, mother's milk supplies most satisfac- 
torily the demands of the system. 

There is generally a substance present in the 
breasts at the birth of the child which acts in the 
nature of a physic upon him, and which rids his 
bowels of the black, tarry substance which fills them. 
It should also be nourishment enough for him until 
the regular supply of milk appears, which is usually 
the second or third day. 

It is well, however, to put him to the breast at 
regular intervals so that he will learn to^ draw on 
the nipple, and also because the act of suckling tends 
to produce contractions of the uterus. After the 
breast begins to secrete milk, the feedings should 
be oftener and from alternate sides, so that the ful- 
ness may be relieved. 



At birth 



Effect of 

first 

sucklings 



INFANT FEEDING 295 

Sometimes, particularly if the breasts have had 
no treatment before confinement, the nipples become 
cracked and extremely painful. This condition may 
be guarded against by the avoidance of pressure 
over the breasts, and by particular cleanliness before 
delivery. 

The regular treatment of the breasts after the 
child is born should be bathing with boracic acid Regular 
solution after each feeding. The special treatment f the 
for chapped or cracked nipples has been given on reasts 
page 248. 

The physical and the mental condition of the Effect on 
mother has its effect on the milk, and hence on the m iik of 
baby. Moodiness, worry, and despondency seem to ^dftion 
affect the quality of the milk almost as much as lack 
of physical tone. 

'Medicine taken by the mother acts indirectly upon 
the babv through the milk, and the food of the mother Medicine, 

& ' w food, 

has to be especially chosen with regard to the baby's alcoholic 
diet. Alcoholic drinks are not advisable, but milk, 
cocoa, and gruels help to increase the supply of milk 
and should be taken in preference to tea or coffee. 

Cereals, eggs, meats, and vegetables, whatever 
would constitute the normal diet, is allowable for a neces- 
the nursing woman, but she should be a little cau- sary care 
tious about eating green vegetables or fruits, and 
should also be very careful to keep her bowels regu- 
lated. 

If a woman keeps herself in good physical con- 
dition she will have enough nourishment for her child, 
and if the child is well nourished with a food that 
meets his needs, he will be able to pass through the The 
difficult periods of teething and the heat of his first milk 
summer with much less danger. This is the reason po^er^f* 
why the mother's milk is so far superior to any arti- resistance 



296 CARE OF CHILDREN 

ficial preparation. It seems to supply a power of 
resistance that is often lacking in other foods, and 
which tides the child over the illness of his first year. 
There are, to be sure, conditions enough which 
When the warrant, even demand, that the baby shall not be 
of the put to the breast. If illness has impaired the quality 
milk S S °f the milk, or if the disease is such that it may be 
impaired communicated in this way, a woman is entirely un- 
fitted for nursing her child. If the mother has an 
excitable temperament, is unhappy, or reluctant to 
take up this duty, if she is extremely busy and does 
not take regular rest and sleep, the milk will prob- 
ably be so poor in quality that it will not be proper 
nourishment. If, on the other hand, the nursing is 
too much of a drain on the mother's health, it is 
better to suppress the milk altogether. 

Sometimes the conditions are such that they can 
be corrected, and a strict observance of hygienic laws 
on the part of the mother will sometimes restore the 
milk to the normal standard. 

WEANING 

There is probably a tendency to nurse a child for 

When a too long a period. He should be weaned at ten 

b^weaned mon ths unless he is not well at this time, or it comes 

in the heat of the summer. For the sake of both 

mother and baby it is well to begin bottle feeding 

before the child is weaned. 

At four months one bottle a day may be given, 
Beginnings a {- s } x months two bottles, from eight to ten months 

of the ' & 

feedings three bottles, and between ten months and one year 
the baby should be weaned. The drain on the sys- 
tem of the mother is very great; and to be relieved 
even of one feeding during the twenty-four hours 
means a little saving. 



INFANT FEEDING 297 

In some cases it happens that there is an over- 
supply of milk, when it may seem almost necessary in case of 
to keep the child at the breast, but more often we supply of 
find the milk growing less after the first few 7 months. millk 
Even if the quantity of milk remains sufficient, analy- 
sis of the quality would probably show that it was 
far below normal, and the tissues of the child would 
soon feel the lack. It must be remembered, besides, 
that even normal mother's milk is not suited to his 
needs after he has passed the age when Nature has 
arranged for that supply to be withdrawn. 

In cases where there is an overabundant supply 
of milk at the time of weaning, it can be disposed 
of and the breasts dried up without any danger of 
caking. The breast-pump seems to stimulate the 
glands, but it has been found that a laver of rubber Suppress- 

. ' ing the 

tissue laid over the breasts, and held in place with a milk with 
light bandage, draws out the milk, and dries up the tissue 
breasts without any difficulties. It should be mois- 
tened frequently in w r ater, and kept scrupulously 
clean. With this treatment the breasts remain soft, 
there is no pain or discomfort, and the supply of 
milk is gradually suppressed. 

Another reason why the occasional bottle feed- a reason 
ines are advisable is that in this way we accustom why . , 

o J occasional 

the baby gradually to an artificial food, and can settle Lottie 
upon something which agrees with him before he is advisable 
dependent upon it alone. 

The actual weaning generally means a struggle, 
but it will be a very short one if the baby has become in actual 
somewhat accustomed to the bottle. After he has weaning 
cried himself tired once or twice and has found that 
he is not put to the breast, he becomes reconciled to 
the new method and accepts the altered conditions. 
A baby is a good deal of a philosopher, but he insists 



298 



CARE OF CHILDREN 



upon making sure that existing ills can not be cured 

before he is willing to endure them. 

One of the difficulties of bottle feeding is the 

care of utensils. These include the receptacle for 

the milk or food, the nursing bottles, and the nipples. 

The safest bottle to use is the "Hygeia," which 

Advantages has straight sides and a mouth about an inch and a 

"Hygeia" half in diameter. It is as easily cleaned as a cup or 

bottle" 8 §l ass > has no angles which are out of reach, and no 

creases where milk can collect. The nipple, instead 




'Hygeia" Nursing Bottle 



of being a long mouthpiece, has more the shape of 
the breast, as it is a curving cover of rubber with a 
small elevation in the centre. In buying, care should 
be taken to choose one having a small hole in the 
nipple, for if the milk comes out too freely the 
baby's stomach can not dispose of it easily, and it is 
liable to form large curds which are often vomited. 
The bottle should be rinsed at once after the 
feeding, and the nipple carefully washed in cold 
water, rinsed with hot, and put to soak in a solution 



INFANT FEEDING 299 

of borax or baking soda — a pinch of either — in a cup 
of water. Once a day the bottles and nipples should Especial 
be boiled after washing in hot soap-suds, and they the nursing 
should always be rinsed with hot water immediately bottles 
before use. Improper care of the nursing bottles 
or in the preparation of the food is responsible for 
most of the cases of summer complaint among chil- 
dren. 

COWS' MILK 

The first choice among foods is herd's milk. It 
was formerly considered that the milk of one cow Herd's 
should be chosen, but so many calamities followed mi 
in the way of accident to that particular animal, the 
drying up of her milk, or the appearance of disease, 
that it is now believed safer to depend on the milk 
from a good many cows. 

It should be put up in bottles at the dairy and 
delivered unopened. Grocerv milk should never be bottled at 

r " the dairy- 

USed for children, for no fluid accumulates and sup- 
ports germs more readily, and it is constantly ex- 
posed to impure, dirt-laden air. 

In large cities milk may be purchased from 
laboratories, where it is not only bottled under sani- Modified 
tary conditions, but is afterward sterilized or Pas- 
teurized. At such laboratories it is also possible to 
have milk especially modified in accordance with any 
formula that a physician may write out. 

The essential, however, is that it is put up in 
clean bottles at the dairy, and is not delivered from 
a general can, which is opened and disturbed in- 
numerable times during its journey. 

MODIFICATION OF MILK 

A few words must be said upon the scientific 
modification of milk, because it is by far the most 



300 CARE OF CHILDREN 

rational method of feeding children, though its ex- 
pense and the fact that the large laboratories are 
principally located in cities, put it at present quite 
out of the reach of the majority. The problem that 
Problem of is presented is to find a food that copies in every 
food that possible detail the fluid that the baby at the breast 
mother's normally receives. The analysis of average human 
milk milk is taken as the basis of the changes that are 

necessary, and the resulting food must be, besides, 
fresh, sterile, of body temperature, and furnished in 
amounts varying with the needs of the child. 

The modification is carried on in laboratories 
Modifica- provided with special apparatus, and is under the 
accord wkh direction of scientists, who prepare the milk in 
prescript S accordance with definite prescriptions sent them by 
physicians. The physician can in this way use his 
judgment about the formula which will best suit a 
child's needs, and in illness can vary the food, know- 
ing that it will be prepared with the same exactitude 
that his medicines are in the hands of the druggist. 
This is without question the ideal method of 
other food preparation, but because it can not be attained 
careful by numbers of mothers living in towns remote from 
ee mg the laboratories or by equal numbers who are unable 
to bear the expense, careful feeding need not be con- 
sidered out of the question. 

Sterilization can be accomplished by putting the 
bottles of milk into water which is raised to the boil- 
ing point and kept there for an hour. It is now con- 
sidered that milk subjected to such a process loses 
some of the qualities that the tissues of the child 
Pasteuriza- require. For this reason Pasteurization is the method 
fe°r?ed r to commonly employed. This is slightly more complex, 
stenhza- b ecause it means that the milk shall remain at a tem- 
perature not exceeding 167 F. for half an hour. It 



tion 



INFANT FEEDING 301- 

is well to prepare the milk as is desired, pour it into 
bottles, and Pasteurize enough" for the twenty-four 
hours' feedings. 

Cows' milk varies enough from the mother's milk 
so that a certain modification is necessary to suit the 
baby's stomach. It is heavier, has more solids, less 
sugar, more fat, and much more albumen, so dilu- 
tion will not accomplish a proper modification. Home 
modification has been made possible by the manufac- Home 
ture of an apparatus which can be obtained for four tion 
dollars at the Walker-Gordon laboratory in Boston, 
Massachusetts, or Freeman's Pasteurizer, which may 
be found at shops dealing in hospital supplies. 

The chief essentials in the preparation of milk 
are, first, that the cleanliness and health of the herd of Essent »ais 

in modi- 

cows shall be assured ; second, that the precautions fying the 
in regard to the care of utensils shall be observed ; 
and third, that the Pasteurization shall be conscien- 
tiously carried out. These points can receive atten- 
tion whether or not the modification follows a physi- 
cian's formula, is carried on in the laboratory with 
complicated apparatus or at home with the simplest 
appliances. 

Jars to set the milk in, generally those in which 
it is delivered, bottles to hold it when readv to Pas- Articles 

necessary 

teunze, a thermometer, a graduate glass to measure in modi- 
ounces, and cotton wadding, which makes the best y,ng 
stoppers, are the necessary articles for an outfit. 

A tin pail or dish can be fitted with a perforated 
plate to hold the bottles upright, and this is quite 
successful for Pasteurization. The water in this dish 
should be at a level with the milk in the bottles. It 
should be cool when they are put in, and should then 
be brought to 167 F. 

It is possible to test the water with the thermom- 



802 



CARE OF CHILDREN 



Keeping 
the water 
at the 



eter till one learns where the dish must be put to 
hold that degree of heat for the required time. Some- 
times the heat of the back of the stove is necessary, 

pXature"" an d sometimes if the pail is wrapped in a blanket and 
removed from the fire entirely the temperature is 
maintained. 

After the process is completed the bottles should 

After the ^ e se j- } n a coo i pj ace an d k e pt there till they are 

process is ■ r ' r J 

completed used. They should be the regular nursing bottles, 




A Graduate Glass 



and the milk should not be poured out to be warmed. 
When it is ready for the child the rubber nipple is 
substituted for the cotton stopper. If the entire 
contents is not taken at a feeding the remainder must 
be thrown out. 

If no attempt is made to feed the baby by a strict 
a formula analysis of liis needs and a doctor's prescription for 
for modi- ^ modification of the cows' milk, what is known as 

fying milk ' 

Meig's mixture is a very gOod formula to follow. This 



INFANT FEEDING 303 

consists of one part milk, two parts cream, two parts 
lime-water, three parts sugar-water. The sugar- 
water is made by adding two heaping teaspoons of 
sugar of milk to a pint of water. 

This formula supplies in a general way the differ- 
ences we find between the mother's and cows' milk. 

Another fact to be taken into consideration is the Mother's 
way the milk is affected by the digestive fluids in Easily" 10 
the stomach. The mother's milk, in the process of fhfr. sted 
digestion, curdles in tiny flakes, while that of the cow cows ' milk 
tends to form hard, solid curds. 

This difficulty may be overcome in part if the 
hole in the nipple is made very small, or if a bit of Sanitary 

., . . , . , and other 

sponge or absorbent cotton is placed in the top so precauti 



oris 



that the baby will have to pull with some effort and digestion^ 
will get the milk by the drop instead of in a steady J^ ™ 8 ' 
stream. If this device is used great care must be 
taken to keep the sponge clean. It must be thoroughly 
washed each time, and often replaced. The absorb- 
ent cotton is safer because it is thrown away each 
time. 

His feeding ought to last twenty minutes, and with 
the ordinary nursing bottle he will generally take the Twenty 
necessary amount in half the time, while the breasts the baby's 
secrete enough between feedings so that it will require time 1 " 8 
that amount of time for a baby to empty them. 

PREPARED FOODS 

There is no question about the superiority of cows' 
milk over the various prepared foods. The difference 
in price should not be considered, because it will be The 
paid back many times over in the increased strength of foods'" 6 
the child. The preparations made on so large a scale l *^ iormh 
lack uniformity, and deviate somewhat from year to 
year. The percentage of sugars and fats is estimated 



304 CARE OF CHILDREN 

on the product as put on the market, but after dilution 
for the infant's feeding, there is great danger that there 
may not be the proper amount of nutriment for his 
needs. 

At all events, a scientific preparation of cows' 

Scientific milk with regard to the age, digestion and develop- 

tionof ment.of a child must of necessity be a superior food, 

better food and the home modification as well furnishes a better 

quality of nutriment. It is too often a question of the 

ease of preparation which is responsible for the choice 

of one of the patent foods as a substitute for mother's 

. milk. 

The number of these foods on the market is almost 
beyond conception. It is very difficult to choose be- 
tween them, and quite impossible to make any state- 
ment that a baby will thrive on one and will not on 
another. If it is impossible to get good herd's milk, 
if the or if for some reason its use is not practicable, one 
foods must of these preparations must be tried, and it is far better 
be used tQ fegfa suc \ l experimenting while part of the nourish- 
ment still comes from the mother. 

Condensed milk is advocated by many authorities, 
and in many cases it seems to be an ideal food. Its 
its care preparation, with boiled water, is simple, and it is easy 
to obtain and to preserve, which makes it especially 
valuable in summer. If it is used, the can should never 
be left exposed to the air, but should be kept in the 
ice-box or a cool place, with a tightly fitting cover over 
it. In the process of condensing one of the important 
Loss in constituents of the milk is lost. This is concerned in the 
which formation of bone tissue, and is one cause for rickets 
bon k e e tissue m babies who are fed exclusively on it. For this rea- 
son, the question arises as to whether it is well for the 
baby to be kept altogether on this food. It also seems 
sometimes as if a condensed milk baby had less re- 



Condensed 

milk and 



INFANT FEEDING 305 

sistance and succumbed to illness more easily than one 
fed upon cows' milk. 

POINTS TO BE NOTED 

If a baby has to be brought up on a bottle, and the 
first food chosen does not seem to provide proper nour- 
ishment, experiments will have to be tried, and this 
must be done with no nervous agitation as to imme- 
diate results. 

The greatest care should always be taken with the 
bottles, nipples, and utensils generally, which are used Sanitary 
in preparing the food, and then the chances of trouble bottles, 
during hot weather will be lessened by half. If thiSand PeS ' 
is done the difficulties are being narrowed down to the utensils 
combination that the child needs, and intelligent re- 
gard to the indications of trouble will help in the choice. 
If the baby vomits and the milk is curdled and sour, what sour 
it probably means that the acid needs to be correct- ^°™ lting 
ed, and an addition of lime-water is made to the food, indicate 
or a teaspoon of it is given just before each feeding. 
Sour vomiting may also indicate too much fat. 

If he does not gain in weight, but seems well, the 
percentage of sugar and fat may need to be increased. What other 
If, on the other hand, with the lack of gain, the flesh may indi- 
seems soft and flabby, if he is fretful, and if the move- cate 
ments of the bowels show undigested curds of milk, 
the tissue-building properties are not being taken into 
the system properly, and the stomach is not able to 
manage its share of the digestion. This means that 
further dilution or a predigestion of the milk may be 
necessary, though the latter should not be long-con- 
tinued, since if the organs of digestion are not given 
enough to do they do not develop properly. 

The distinction between vomiting and regurgita- 
tion should be remembered. When the stomach is 



306 



CARE OF CHILDREN 



Distinction filled too full, it literally runs over, which is quite a 
vomiting different matter from the throwing out of food that 

gi n tat[of Ur " has been actecl u P on b >' the digestive fluids. Milk 
which is regurgitated is unchanged in odor and ap- 
pearance, and is thrown up very shortly after a feed- 
ing. 

The temperature of the food makes a difference in 
ufrToTthe t ^ ie ease °^ digestion. It should be about body heat, 
baby's food between 98° and 99° F., and should be brought to 



Never put 
the nipple 
of the 
baby's 
bottle in 
your 
mouth 




Stomach of Infant Five Days Old (Natural Size) 

that point by putting the bottle into hot water. It 
is easily tested by allowing the milk to trickle over 
the hand. 

The nipple should never be put into the mouth of 
the mother or nurse. It is, in the first place, taking an 
unfair advantage of the helpless baby to subject him 
to treatment that a grown-up person would resent; 
and there is besides the more serious ill — the danger of 
communicating the germs of disease. A baby is very 
susceptible, and a mild disorder in the adult may be re- 
produced as an acute condition in the child. The gums 
and teeth are rarely in a state of absolute cleanliness, 



INFANT FEEDING 



307 



and it is impossible not to transfer micro-organisms 
if the nipple is not thoroughly washed. 

It is rather important that the size of a baby's 
stomach should be taken into consideration when the 
amount of the feeding is being decided upon. At 
birth the capacity is from five-sixths 
to one ounce ; at the end of the first 
month it has increased to two and a 
half ounces ; twenty weeks finds it 
holding three ounces and six-tenths, 
and at the end of the year it holds 
eight ounces. 

These dimensions should be kept 
in mind in feeding a bottle baby, for 
the tendency is always toward over- 
feeding. It requires about an hour 
to digest the milk, so the two-hour 
interval gives the stomach sufficient 
time for digestion and for rest be- 
tween feedings. The subject of 
feeding in disease will be taken up 
in a later chapter. 

A baby will generally lose in 
weight for the first five days or a 
week after birth. Then he should average a gain of a 
quarter of a pound a week, for five or six months. The 
more a child weighs at first, the more he loses as a 
rule, a seven-pound baby often holding his own when 
one of ten pounds will drop to seven. 

Steady decrease in weight after the first week means 
a lack in nourishment. For this reason the advice of 
some authorities, that the amount of a baby's feedings 
should be what he can and will take, may be accepted 
with limitations. If he is overfed, the surplus will 
flow back — regurgitate, to be sure; but first it will 



Sizes of 
the baby's 
stomach 




Tendency 
to over- 
feeding 



Glass Cylinder Showing 

the Capacity of the 

Stomach 



What the 
baby's gain 
in weight 
should be 



What de- 
crease in 
weight 
means 



308 



CARE OF CHILDREN 



distend the stomach and cause uncomfortable feelings, 
which will be strenuously resented. This is not de- 
sirable, and it seems better to plan a 



Schedule 
for the 
first week 



Between 
the first 
and sixth 
week 



From 
six weeks 
to ten 
months 



SCHEDULE FOR FEEDING 

A definite schedule allows us to approximate the 
amounts given as the changes are made from week to 
week. 

In general, then, for the first week, a baby should 
be fed every two hours, an ounce — two tablespoons at 
a feeding. There should be ten of these feedings 
given during the twenty-four hours, and the whole 
amount taken in that time should be ten ounces. 

Between the first and sixth weeks the intervals may 
be lengthened to two and one-half hours, and the 
amount is then gradually increased to two ounces. 
This brings up the total to from twelve to sixteen 
ounces, and there need be only nine feedings in the 
twenty-four hours. 

From six weeks to ten months, the baby will need 
nourishment every three hours, but the amounts of the 
feedings increase, and the number decreases, till from 
four ounces we have come to eight, and we are giving 
only five instead of seven in the twenty-four hours. 
This means that the night is entirely unbroken, from 
six to six, or whatever hour may be chosen for the 
morning meal. To sum up, then, we may represent it 
all by the following schedule : 



Age 


Intervals 

2 hours 

2% " 

3 " 
3 " 
3 " 
3 " 


No. IN 
24 hour; 
10 

9 to 8 
7 to 6 
6 
6 
5 


Amount at 
each feed 


Amount in 
24 hours 


i week 

i to 6 weeks 

6 to 12 " 

5 months 

6 " 
io " 


1 ounce 

i}£ to 2 ounces 

3 to 4 

5 
6 
8 


10 ounces 
12 to 16 " 
21 to 24 " 

30 
36 
40 



. INFANT FEEDING 309 

It must be understood that this is not absolute. 
Some authorities advocate giving the baby two ounces Variations 
for his first feeding, and some vary the total amounts guide 
or the intervals in such a way that the results are 
slightly different, but this is reliable for a guide, and 
that is all one needs. Observation will teach one what 
the deficiencies are. 

Proper treatment of a child requires above all cool 
judgment, rational thought, and the intention of fair Proper 
play. Emergencies that arise are often alarming only of a child 
because they are not met with the good sense of a J2J-SS? 
steadv brain, and if the reason that is required in all thought 

* and j usl 

other problems of life were used with regard to the 
puzzles in feeding, in hygiene, and in physical and 
moral training which come up during the life of a 
child, we should have men and women in the coming 
generations who would be more evenly developed 
physically and nervously and who would have a saner 
outlook upon life in general. 

MEASURES FOR THE HOUSEHOLD 

i teaspoon about a dram 

i tablespoon about half an ounce 

i wineglass about two ounces 

i teacup about four ounces 

i coffee-cup or i drinking glass . . about eight ounces 



rational 
t 
tice 



II 



DIETARIES 

Digestion— Needs of the Child— Diet Lists from Eleven Months to Three 
Years and a Half— Sweets for Children— Family Breakfast- 
Family Dinner— Supper— The Child at Table 



The ali- 
mentary 
canal 



T 



DIGESTION 

HE digestive apparatus consists of a long tube 
of varying shape and size, which passes through 
the body, the entrance being the mouth and the exit 
the rectum. There is no direct communication be- 
tween this tube and the rest of the body, though there 
are intimate relations through the blood-stream which 
gathers its nourishment from the food after it has been 
chemically treated in this natural laboratory. 

In the feeding of both children and., adults, better 
results can be attained if there is a little recognition of 
the processes that are going on in the digestive tract. 

The digestion of foods means the reducing of them 

by the action of the digestive fluids into such a con- 

foodmeans dition that the nutrient substances they contain may 

be taken up by the blood-stream, and thus distributed 

to the various tissues of the body. 

Digestion begins in the mouth, and is assisted by 

Digestion a chemical substance contained in the saliva, and by the 

the mouth mechanical act of grinding, by the teeth and turning 

over and over by the tongue and cheeks. In this way 

the food is reduced to a pulp and thoroughly exposed 

to the action of this digestive fluid. The chemical 

action of the saliva is upon the starches, which that 

fluid converts into sugar and puts into soluble form. 

(310) 



What di 



DIETARIES 311 

Such substances as bread, cereals, and potatoes then 
need to be thoroughly masticated in order that their 
digestion may be begun. 

In the stomach, which is the next portion of the What part 
tube, the gullet being simply the passage into it, the f 00 d the 
starches undergo no change, but it is such foods as ^"^ 
milk, lean meat, and white of egg which are treated u P° n 
by the gastric fluid. 

The fats and the starches which have escaped 

the action of the saliva, together with whatever the What 

1 1,,- i work the 

stomach has not acted upon, are thoroughly digested intestinal 

in the intestines, where also most of the absorption 3^°° 

takes place. The residue — the waste matter which P hshes 

is of no service to the system — passes along and is 

thrown out in the daily evacuation from the bowels. 

NEEDS OF THE CHILD 

As long as the digestion of a little child is normal 
it is unwise to give it any amount of starches to dis- 
pose of. They will pass on to the intestines entirely 
unchanged, and it is better to put more of the work 
upon the stomach. 

Milk contains all the constituents needed by the Do not 
tissues, and does not require any digestion in the fhiM solid 
mouth. When this is understood it is readily seen f ood until 
how absolutely unwise it is to give a child solid food teeth to 
until he has a sufficient number of teeth to masticate STfooV 
properly. 

Bread and potato can be made soft enough for a 
baby to swallow long before he has teeth, but to 
give them before he can chew means that they 
hardly come into contact with the saliva at all. There 
may be some action, because the chemical which 
saliva contains is very powerful, but Nature's pro- 
visions are generally to be trusted, and when the 



312 CARE OF CHILDREN 

system needs the varied dietary, the teeth, the 
mechanical aids to digestion, will be ready. 

In illness it sometimes becomes necessary for the 

When ill- stomach to be temporarily relieved of its work, and 

change then we are glad to know what to eliminate from the 

of diet diet in order to throw the task of digestion upon 

the intestines alone. 

As long as a child is nursing, up to the tenth 
month at least, there is no need of variation in diet, 
provided the health remains good. If he is a breast- 
fed baby he has already begun to have at least part 
of his feedings from outside sources, so that his food 
is not all of exactly the same quality. 

After the tenth month he can be given broths or 

Proper beef-juice occasionally, and by the time he is a year 

a ro IT °^ ^ e can ^ ave °l u ^ e a ^ ew changes from the regular 

food for milk diet. Between the eleventh and twelfth months 

after he he should be weaned from the bottle by being given 

months old 'it only for the first and last meals. He should on no 

account be nursed from the breast after he is a year 

old. The mother's milk is no longer suitable food, 

and will not supply him with the constituents needed 

by the blood for the building up of the tissues. The 

bones should be growing firmer, so that the weight 

of the body can be borne, and the necessary material 

for this work can be better supplied by other foods. 

The quality of the blood also becomes impoverished 

if the mother's milk is the only food. There may 

be exceptional cases where the milk remains rich and 

abundant enough, but as a rule the mother's system 

is depleted by the long strain, and the milk is poorer 

in quantity and quality. 

Changes in a child's diet should be made very 
slowly, and he should be watched carefully after 
each change, to see if it agrees with him. One addi- 



DIETARIES 313 

tion only should be made at a time. If the mother Changes in 
has decided to introduce broth into his bill of fare, should be 
she should substitute a portion of that for one of ° n t ; n ** 
the milk feedings and let that suffice for the first day, 
unless the occasion is one of illness, when it is neces- 
sary to eliminate the milk. 

She can then observe the effect of the change 
on the child, and regulate the next feedings accord- The 1 mo , t J" 

& & er should 

inglv. It must be remembered, too, in giving broths, watch 

effects 

that unless bread, rice, barley, or spaghetti is added 
to them, they are stimulants rather than foods. The 
fat is skimmed off and the tissue-building properties 
are in the meat which is rejected. As a stimulant 
broth has an important place in quickening the appe- 
tite and in aiding digestion. 



DIET LIST FROM ELEVEN MONTHS TO 
THREE YEARS AND A HALF 

A diet list for children between the ages of one 
and three and a half years may be put in a condensed 
form as a suggestion to mothers who may have a 
little doubt as to the proper foods and their methods 
of preparation. 

From Eleven to Twelve Months. Five Meals 
a Day 

first meal, 7 a. m. 

Cream one tablespoon 

Milk fifteen tablespoons 

Milk sugar one teaspoon 

Salt .a. pinch 

Water (boiled) four tablespoons 

SECOND MEAL, 10. 30 A. M. 

* A breakfast cup of warm milk. , r . 

14 l Vol 3 



314 CARE OF CHILDREN 

THIRD MEAL, 2 P. M. 

The yolk of an egg lightly boiled, with stale bread 
crumbs. 

FOURTH MEAL, 6 P. M. 

The same as second meal. 

FIFTH MEAL, IO P. M. 

The same as first meal. 

On alternate days the third meal may consist of 
nate a da r *s ^ rom ^ our to s ^ x ounces of mutton, chicken, or beef 
. broth, containing a small quantity of stale bread 
crumbs. A small piece of unsweetened zwieback or 
dry toast may be used instead of the stale bread. 
Toward the end of the period indicated above the 
strained juice of an orange or a tablespoon of prune 
jelly may be given. 

PRUNE JELLY 

Soak the prunes overnight in cold water; the 
next morning add enough fresh cold water to cover 
the prunes; then stew slowly for an hour or two, 
until they are very soft, adding water from time to 
time to keep the prunes covered. When they are 
done rub them through a fine sieve, add a tablespoon 
of molasses to a pint of prune pulp, and stew again 
for about half an hour. If the child is troubled with 
constipation this jelly and the fruit- juice are valu- 
able additions to the diet. 

EGGS FOR THE CHILD 

The eggs should either be boiled very lightly, or 
else so thoroughly cooked that both yolk and white 
will crumble when the shell is broken. If soft-boiled 
they should not be kept in more than three minutes 
if the water is continuously boiling, and about seven 
if they are cooked at the back of the stove in water 



DIETARIES 315 

that has reached the boiling point just before the 
eggs were added. If the second method — that of 
thorough cooking — is used, they should be thoroughly 
cooked in water at the boiling point for an hour. 
Eggs cooked in this way are especially digestible, 
and will be found to be quite dry and mealy. The 
yolk of an egg is more easily digested than the white. 

From Twelve to Eighteen Months. Five Meals 
a Day 

first meal, 7 a. m. 
A slice of stale bread, broken and soaked in a 
breakfast cup of new milk. Or two tablespoons of 
well-cooked and strained porridge, oatmeal or 
cracked wheat, with two tablespoons of cream and a 
little salt, no sugar; a breakfast cup of new milk. 

SECOND MEAL, IO A. M. 

A teacup of milk, with a soda biscuit, or a thin 
slice of lightly buttered bread. 

THIRD MEAL, 2 P. M. 

A teacup of beef, mutton, or chicken broth, with 
a slice of bread. One good tablespoon of rice and 
milk pudding. 

FOURTH MEAL, 6 P. M. 

The same as first meal. 

FIFTH MEAL, IO P. M. 

A breakfast cup of milk, with or without the addi- 
tion of a cereal. 

To alternate with this: 

FIRST MEAL, J A. M. 

The yolk of an egg lightly boiled, with bread 
crumbs and salt. A teacup of milk. 



316 CARE OF CHILDREN 

SECOND MEAL, IO A. M. 

A teacup of milk with a soda cracker, or a thin 
slice of buttered bread. 

THIRD MEAL, 2 P. M. 

A mashed baked potato, moistened with four 
tablespoons of meat broth; two full tablespoons of 
junket with cream. 

FOURTH MEAL, 6 P. M. 

A breakfast cup of milk with a slice of dried toast 
or zwieback broken up and soaked in it. 

FIFTH MEAL, IO P. M. 

A teacup of milk. 

The fifth meal is often unnecessary, and the child 
should never be disturbed for it. Very often he will 
wake early, at five or six in the morning, and can 
then be given a cup of warm broth, instead of taking 
the io p. m. feeding. 

OAT JELLY 

Four ounces of coarse oatmeal are allowed to 
soak in a quart of cold water for twelve hours. The 
mixture is then boiled down so that it will make a 
pint, and is strained through a fine cloth while it is 
hot. When it cools a jelly is formed, which is to 
be kept on ice till needed. A little salt improves the 
jelly if it is to be eaten cold. 

From Eighteen Months to Two Years and a 
Half. Four Meals a Day 

first meal, j a. m. 
A breakfast cup of new milk; the yolk of a 
lightly boiled egg, with a little butter and salt; two 
thin slices of bread and butter. 



DIETARIES 317 

SECOND MEAL, 1 1 A. M. 

A teacup of milk and a soda biscuit. 

THIRD MEAL, 2 P. M. 

A breakfast cup of beef, mutton, or chicken broth; 
a thin slice of stale bread ; a saucer of rice and milk 
pudding. 

FOURTH MEAL, 6.3O P. M. 

A breakfast cup of milk with bread and butter. 
To alternate with this : 

FIRST MEAL, 7 A. M. 

Four tablespoons of well-cooked porridge, oat- 
meal or cracked wheat, with two tablespoons of 
cream and a little salt (no sugar) ; a teacup of milk. 

SECOND MEAL, II A. M. 

A teacup of milk and a soda cracker. 

THIRD MEAL, 2 P. M. 

One tablespoon of underdone mutton pounded to 
a paste ; bread and butter or mashed potato moistened 
with good plain dish gravy; a saucer of junket. 

FOURTH MEAL, 6.3O P. M. 

A breakfast cup of milk; a slice of soft milk 
toast or a slice or two of bread and butter. 

The receipt for junket has been given on page 214. 

RICE PUDDING 
The rice pudding is made as follows : Five cups 
of milk, two tablespoons of rice, half a teaspoon of 
salt, one-third of a cup of sugar. \Yash the rice, 
mix the ingredients and pour into a buttered 
pudding dish. Bake from two to three hours in a 
very slow oven, stirring three times during the first 
hour of baking to prevent the rice from settling. 



318 CARE OF CHILDREN 

-9 

From Two Years and a Half to Three Years 
and a Half. Four Meals a Day 

first meal, 7.3o a. m. 
One or two drinking glasses of milk; a saucer 
of thoroughly cooked porridge, wheatena, cream of 
wheat or oatmeal, and one or two slices of bread, 
one day old., with butter. 

SECOND MEAL, IF HUNGRY, II A. M. 

A glass of milk or a teacup of meat broth with a 
biscuit. 

THIRD MEAL, 2 P. M. 

A slice of rare roast beef or mutton, or a bit of 
roast chicken or turkey minced as fine as possible; 
a baked potato thoroughly mashed with a fork, and 
moistened with gravy ; a slice or two of bread and 
butter; a saucer of junket or rice pudding. 

FOURTH MEAL, 7 P. M. 

A glass of milk; one or two slices of bread and 
butter or of well-moistened milk toast. The fourth 
meal may consist of porridge, bread and butter, and 
milk, if the child likes the cereal well enough to 
take it at two meals. If there is special need of 
laxatives a little baked apple or stewed prunes may 
be added to this meal. 

SWEETS FOR CHILDREN 

During the first years of childhood, the diet should 

Keeping be very similar to the foods in the above lists. A child 

tastes will become accustomed to simple food if he is always 

simple o-i ven it, and he will even accept as a matter of course 

a difference between his fare and that of his parents 

if that difference is constantly made, and he is never 

allowed to "taste" of dishes that appeal to him because 



DIETARIES 319 

they are unusual. It is extremely unwise to give a 
young child cake or candy or any rich sweets. The 
system needs sugar, it is true, but it can be supplied 
quite easily in the regular diet. 

Simple sweets do not necessarily have a bad effect 
on the digestion, but they create a perverted taste, and Sweets 
interfere with the healthy appetite for the food which taste and 
is most healthful and nutritious. If a child does not unTeaHhy 
know the taste of cake or candy, he will feel no de- a PP etite 
privation, and when he is old enough to choose for 
himself, he will be far less likely to have an unnatural 
desire for them. 

FAMILY BREAKFAST 

It is very easy to make the breakfast of the family 
one which is equally suitable for the children. Fruit, children 
either raw or stewed, a well-cooked cereal, toast, and, if ^""mii 
desired, some other very light dish, eggs, or minced breakfast 
meat, or fish, make a meal that may be shared by all. 
The adults may add their coffee to this, but there is 
no excuse for giving it to children. Milk and water 
are the best drinks for children, and they will usually 
take them, unless their taste has been perverted. 
Cocoa can be occasionally given, when there is no hot 
dish included in the meal, or if the child can not drink 
milk. 

Tea and coffee are distinctly bad for children, and 
yet there are mothers who give them to their babies. Never gh-e 
in the nursing bottle, for no reason but the effects, coffees 
most deplorable, which the tender body clearly shows. children 
The stimulant acts upon a child as it does on an 
adult, giving him a sense of satisfaction and of well- 
being that ought to be derived from the nourishment, 
and from physical vigor. After the child gets older, 
he craves the tea or coffee, and if he gets it, he de- 
mands far less in the way of solid food. 



320 



CARE OF CHILDREN 



A woman can feed her children on tea and bread 
Evil effects when poverty is pinching, simply because the tea sup- 
plies artificially and temporarily what heartier diet 
would give permanently, and takes away the healthy 
appetite of the growing children. It lays no founda- 
tion for resistance in time of need, and debilitates the 
nervous system most surely, by depriving it of the nour- 
ishment it demands, and by exciting it continually with 
a stimulant that ought to be quite uncalled for. There 
is a brand of cocoa on the market which, claims to have 
special nutritive value. It is called "Plasmon Cocoa," 
and contains besides the cocoa the nutrient constitu- 
ents of milk, condensed and in the form of powder. 
"Phillips' Digestible Cocoa" is considered very light, 
and particularly suitable for children or invalids. Di- 
rections will be found on the boxes. 



Cocoa as 
a drink 



The din- 
ner in 
which 
children 



FAMILY DINNER 

The midday meal should be the hearty one for 
children, so that if the family takes its dinner at night 
it is a better plan for supper to be served in the nursery 
at an earlier hour. 

The dinner may begin with a clear soup. The 
meat or fish should be roasted or boiled, and cut into 
fine pieces. The potatoes are most digestible baked or 
may d share m ashed, and there need be only one other vegetable. 
Hominy, plain macaroni, spinach, peas, stewed celery, 
cauliflower, new string beans, and green corn, if it is 
grated from the ear, are vegetables that children 
can digest. 

Fried food should be avoided, and no condiment 
but salt need be used. The dessert should be a light 
pudding, like rice, custards, tapioca, or gelatine. 

The seasons should be considered in the choice of 
foods. Oatmeal, cornmeal, fats of any sort, food con- 



DIETARIES 321 

training much butter in its preparation, or bacon, are Consider 
heating and not suitable for warm weather. The wheat i n choos- 
cereals, fruits, vegetables, fish and salads are less heat- ing food 
ing, and are more satisfactory for the hottest weather. 

SUPPER 

The supper should be a very simple meal, such as 
has been described. Milk or cocoa may be given, and Asim P le 

J & supper 

toast or bread with porridge, or some stewed fruit will 
furnish sufficient nourishment. If the breakfast is 
taken early, and the dinner late, especially if the child 
is very active, it may be wise to give a luncheon in the . 
middle of the forenoon. This may consist of a glass 
of milk, and some sort of biscuit. Animal crackers 
are a delight to most children, and graham biscuit, or 
butter thins may be alternated. 

THE CHILD AT TABLE 

Children should always take at least two meals a 
day with their parents or an adult attendant, so that children 
they may be taught to eat slowly and masticate thor- taught tcf 
ougrhly. A child can learn to handle his knife, fork, eat J s,owl > r 

& J ' ' and to 

and spoon properlv if a little trouble is taken with him. masticate 

T . ., . i'ii r iii-ri thoroughly 

It is a mistake to give a child a spoon for all his food, 
for it accustoms him to it, and he is awkward when 
he begins to use a fork. A child should be expected 
to take his food daintily, and will soon learn to keep Muscular 
his place at the table tidy if he is ordinarily devel- and^dain- 
oped in muscular control, and has not been allowed to tiness 
feed himself before his hands have grown strong and 
steady enough. 

In planning meals for the child or the adult, the ap- 
petite as a factor in digestion must be recognized and 
considered. If food is not pleasing, it will not be taken 
in the first place, and secondly, if it is taken with no 



322 CARE OF CHILDREN 

pleasure attendant, it is almost never as completely di- 
gested. 

Before dietaries had become so varied, the appetite 
a guide was a reliable guide in the choice of food, and what 
dietaries man craved was what he needed. We realize that with 
were so j^e i ncrease i n kinds of foods, and in the manner of 

varied 

their preparation, that keenness of instinct is lost, but 
. there must still be a sense of "relish" if we are to get 
the full amount of nourishment from our daily meals. 
Variety, attractive preparation, and attractive serv- 
Aids to ing are important aids, and though they are less es- 
sential with children having the normal appetites of 
abounding health, they will be found worthy of consid- 
eration. 
Memtai ^ 1S °^ educational value for children to sit down 

effect of to a well-set, tidy, attractive table, and the orderly 

an orderly . . . 

meal meals, at regular times, affect his habits of mind as 

well as his habits of digestion. 



Ill 



SCHOOL-CHILDREN — THEIR FOOD AND 
EXERCISE 

Breakfasts — Luncheons— Physical Activities and Mental Development- 
Health and Education 

THE diet list given on the foregoing pages is quite 
suitable for children of any age, and even the 
adult members of a family would find that with occa- 
sional modification its suggestions furnish food that is 
nourishing enough to satisfy the daily demands, and 
sufficient in variety to stimulate appetite, unless elabo- 
rately made dishes or rich and unusual foods have 
spoiled them for simple, wholesome fare. 

BREAKFASTS 

Breakfast is usually the meal that seems the most 
difficult with school-children. In the home where 
there are several children, and where the task of The pull 
dressing them and getting them all off to school {^inning 
comes on the mother, nine o'clock seems rather of the da * 
early, and the breakfast is likely to be a very hurried 
meal. Either on account of the feeling of haste, or 
because the functions of the body are still dormant, 
the appetite is often capricious, and any nourishment 
is taken with difficulty. 

If children are accustomed to the simple meal, so 
that it seems sufficient, the appetite will be much more Va iues of 
likely to be tempted bv it than bv the array of hearty the simple 

e i 1 11" -i 1" - « - « breakfast 

food that used to be considered an essential for the 
American breakfast. When there is no servant, the 

(323) 



324 



CARE OF CHILDREN 



Breakfast 
should 
not be 
hastily 
taken 



economical side of the question would recommend it, 
for the saving of labor is always worth consideration. 
The fruit, cooked or uncooked, needs no preparation in 
the morning; cereal, toast, and coffee take very little 
time, and the eggs for those who wish them can 
be boiled or dropped with very little hurry or work. 
Breakfast should not be hastily eaten, because the 
abundance of starchy food needs thorough mastica- 
tion. It is well to vary the cereal several times dur- 
ing the week, and to give, in general, wheat prep- 
arations rather than pats. All the varieties need longer 
cooking than is recommended in the ordinary direc- 
tions. Consult the article on the cooking of cereals in 
the Every Day Cook Book. Hominy and cracked 
wheat must be put on the night before, for they are ex- 
tremely indigestible unless very thoroughly cooked. 

LUNCHEONS 

The luncheon problem is a serious one in many 
households, because of the burden of preparing some- 
thing every day, and still more on account of the lim- 
schoois ited choice of suitable food. When the school hours 
are so arranged that a luncheon is a necessity, there 
ought to be some arrangement for serving the whole 
or a part in the school building. This is provided for 
in many schools, and would be in many more if the 
parents brought it to the notice of the boards and in- 
sisted upon its accomplishment. 

Hot soup, or hot or cold milk, adds to the nourish- 
ment and to the pleasure, and if the luncheon takes 
the place of the noonday meal, is quite a necessity. 
The simplest arrangement would be tanks of cocoa, 
or bouillon, and of hot milk and water. 

Beef tea, made with tablets or capsules, and malted 
milk could then be prepared as they are desired, and 



Luncheon 



Arranging 
for soup, 
milk, etc. 



FOOD AND EXERCISE 325 

with sandwiches from home a child could make a com- 
fortable, suitable meal. The fact of having a definite 
place where pupils can sit together and eat comfort- 
ably, the sociability, and lack of haste promote diges- 
tion. 

Unless the entire luncheon is prepared at school, 
the home basket must be furnished daintily if its con- 
tents are to be appreciated. Children who have nor- Putting 

., . • . . up school 

mally hearty appetites, and who are not sensitive to luncheons 
appearances, may think more of the quantity given than 
of the exquisiteness of its preparation. But, however 
that may be, it is better for the child, from the educa- 
tional standpoint, to find his sandwiches cut thin and 
small, and carefully wrapped in parafine paper or in 
a napkin, with whatever may be added daintily packed 
in a suitable box, than to take an equally nourishing 
lunch carelessly put up in a brown paper parcel. This 
subject of luncheons for school-children is also treated 
in the Every Day Cook Book. Sandwiches always 
suggest themselves as the staple of any lunch of the Sand- 
picnic order, and their variety is legion. A simple ^ their 
cake, a piece of gingerbread, or some fancy biscuit, E an°JJJ ents 
fruit or a little sweet chocolate, or bit of pure candy 
added as an occasional surprise, is quite adequate if 
supplemented at the school by milk or a hot soup, or 
if the luncheon does not take the place of the meal, 
but merely bridges a space between breakfast and a 
late dinner. 

To these general suggestions are appended some 
directions for making the less common varieties of 
sandwiches, which may serve to change an otherwise 
monotonous fare, and will add the element of surprise, 
which is such a stimulus to appetite. 

White, graham, or brown bread, or fresh small 
rolls may be used for sandwiches. 



326 CARE OF CHILDREN 

Bread should be a day old and fine in grain, and the 
Bread in sandwiches cut to better advantage if the loaf is nearly 
oAhe 3 mg square. If the crusts are to be trimmed off, it is bet- 

sandwich ter tQ cut them from the loaf ^ Then there is nQ waste 

of butter, and the crusts can be dried and used for 
crumbs. The first slice may be spread on the loaf, 
but the second must be cut first in order to make them 
fit. Generally, both slices must be buttered, but only 
one need be spread with the filling. They may be cut 
into squares or triangles, or with a biscuit or cake cut- 
ter into other shapes. 
Butter The butter should be slightly warmed, so that it 

for the to ./ > 

sandwich can be evenly spread, and the bread will not be torn. 

Slices of meat, unless it is very tender, are awk- 
ward for sandwich filling. It should at least be cut 
in small pieces, and is better chopped finely, and mixed 

meats""* with a little stock, cream, or dressing to make it moist. 

sandwich Fish can ^ e pounded to a paste, or potted meats can 
be used, though they are usually too highly seasoned 
to be advisable. A little seasoning, like salad dress- 
ing or lemon- juice, improves the insipid meats or 
fish. 

EGG SANDWICHES 

I. Cut hard-boiled eggs into slices; sprinkle with 
salt, and spread with butter, which has been mixed 
with finely chopped watercress. 

II. Add to the above a layer of lettuce leaves - and 
salad dressing, omitting the cress. 

III. Chop the eggs fine or mash them with a fork, 
seasoning them and mixing them with salad dressing. 

LETTUCE SANDWICHES 

Crisp lettuce leaves may be sprinkled with salt, and 
laid between the buttered slices of bread, or the bread 
may be first spread with salad dressing. 



FOOD AND EXERCISE 327 

CHICKEN SANDWICHES 
Celery added to chicken and chopped very fine 
makes delicious sandwiches. 

CHEESE SANDWICHES 
Cottage or ordinary dairy cheese is spread on the 
well-buttered bread, a little salt is sprinkled over it, 
and with the dairy cheese a bit of French mustard is 
an addition. 

NUT SANDWICHES 

Spread thin slices of Boston brown bread with 
chopped nuts, adding a little salt. 

SWEET SANDWICHES 
Jam, jelly, marmalade, or any preserved fruit, 
makes sandwiches that are very popular with children. 

PHYSICAL ACTIVITIES AND MENTAL 
DEVELOPMENT 

During the first twenty-five years of a person's 
life the influences which enter it have a vital impor- 
tance. Character is being made, habits are being 
formed, knowledge is being stored, which not only The far- 
determines what the life of that person shall be, but effect of 
which decides what sort of inheritance he shall pass training 
on to the next generation. One can never be sure 
whether the child whose equipment in life one has 
undertaken will in turn take upon himself the like re- 
sponsibility of bringing children into the world and fit- 
ting them for its duties, but he ought to be given, for 
his own sake, the chance for the fullest possible de- 
velopment, that he may get from life the deepest pos- 
sibility for lasting joy. 

Until the age of fifteen, there is usually little as- 
sumption of responsibility, and little consciousness of 



328 CARE OF CHILDREN 

The child's the purpose underlying school work. This is as it 
scious should be, and the child's training should follow along 
gaming these lines, letting him gain knowledge without realiz- 
ing that it is part of a scheme of education, and form- 
ing his powers so that he can see and will and choose 
to know when the time for decisions comes. 

Our time is one of upheaval along educational lines. 
The old theories have been tried and found lacking. 
We get the record from the elementary school that chil- 
dren's growth is largely arrested during the school 
■aside" 8 year, and that those who are not placed in school until 
the old after they are seven or eight vears old are stronger 

theories J & & 

than school-children of the same age. School, which 
ought to be reckoned among the pleasures of child- 
hood, so often stands in their estimation as one of its 
tragedies. 

One great truth has been conceded : that children 
need more appeals to their sense-perceptions and 

Fewer de- fewer demands for abstract thought. The general re- 
mands for . 
abstract suit of this concession in some of the public schools 

1 oug * has been that a mass of extra work has been thrown 
upon the teachers, and that the children have been con- 
fronted with a bewildering assortment of accessories 
in the way of colored objects, pictures, and so forth, 
without being relieved of the strain of the former 
work. 

The results have been hardly more satisfactory, for 

very obvious reasons. The child loves to learn. From 

the moment that the baby's -fingers begin investigations 

Child's de- with his own toes, he is eager, demanding, insistent for 

IhoZTbe knowledge. What does the child need most in these 

along bod- years that are given to us to mold? How does he 

ily activity ' ° _ 

gain his knowledge of the things that are vital to him r 
He needs to be given the chance for the normal bodily 
development, and for the most untrammeled activity, 



FOOD AND EXERCISE 329 

because not only the physical but also the mental poise 
depends upon it. 

A child's method of mastering a new and difficult 

, 1 • -i 1 , . . , , The child's 

problem is never to sit down and approach it with ab- method of 
stract theories. His is the plan of the true scientist. mas ery 
He conducts personal investigations, he makes un- 
ceasing inquiry, and he lives the thing he wishes to 
know till it is a part of him. This is the key of the 
situation. The mental processes of the child express 
themselves in action, and since the mental and 
physical activities are naturally associated how can 
the dissociation of them in school work good re- 
sults ? 

"Physical culture" — that is, the set drills and calis- 
thenic exercises, which are a part of the day's routine 
in many classrooms, have their place. They relieve physical 
the tense muscles, and if well directed are of value in defective 5 
correcting defects in position, in carriage or in the de- 
velopment of muscles, which might seriously affect the 
health. Regarded from the standpoint of education, 
they have no special meaning. They are given of 
necessity under the exact direction of the instructor, 
whose ideas thev express. The effort at concentra- XT . .. 

1 , No mdi- 

tion, and the necessity of prompt, unreasoning obedi- viduaiity is 
ence to commands, are conditions which are created by 
the plan of the exercises, by the limitations of space, 
and the numbers working at one time. 

Work in a gymnasium, where the element of sport 
comes in, and the exercises, increasing in difficulty, in- 
cite the child to individual effort and interest, has both 
the educational and the hygienic side, and is an essen- 
tial factor in development. 

Physical education should not be limited to an hour 
or two twice a week. Since it is through physical ac- 
tivities that all other development is gained, the aim 



330 CARE OF CHILDREN 

should be to associate all the work of the early school 
years with such physical activity. 

If one estimates the value of the first years of 
ah the school life by the amount of abstract facts stored up, 
early ° f or ^y the quantity of symbols mechanically learned, it 
school m ay be that the conventional methods of teaching 
should be would seem to achieve most. If, on the other hand, 
w7th C1 physi- one balances the results with the mental and physical 
ties 30 * 1 ™ con trol, with the ability to use the mind and to co- 
ordinate the muscles, and with the increased bodily 
vigor, which are accomplished facts when the modern 
educator is allowed to carry out his ideals, we must 
admit that childhood is a more joyous time, that youth 
will be one of stronger, more purposeful endeavor, 
and that adult life will stand for larger achievement. 
A person's interest is really the secret of his ac- 
The nat- quirements. The interests of the child are manifold 
est and if the mind is allowed to unfold naturally and is led, 
oTthe aClty not forced, into the new channels. At eight, he will 
child m teach himself to read with tireless industry, because 

acquiring J 7 

knowledge f the world of wonders which the magic symbols un- 
lock to him, while at five he toils along the dead level 
road of commonplace to glean such valuable truths as 
"The cat has a rat," or "I see the cat," and literature 
has no attraction for him. 

The introduction of handwork, if it is given its 
proper place in the dav's work, offers a solution 

Intro- « . - , , . \ ,. , < 

ducing which has proved its value bv thorough expenmen- 

knowledge . _, . , 1 , 

by hand- tation. The weaving and sewing do not become 
isolated subjects, but associate themselves naturally 
with history and geography; the abstractions of 
number and form become vividly concrete when 
applied to carpentry, and the cooking processes lead 
to simple chemistry, by the direct path of cause and 
effect. 



FOOD AND EXERCISE 331 

In this way the conventional subjects are not 
thrown aside. They are woven into the general 
scheme so that dry facts do not confront the child, 
but interest colors them and makes them living. 

The object of the industrial education is not to industrial 

1 1 ttt , • • t education 

teach trades. \\ e are not making artisans, but men is not 
and women, and as we lay the foundations of educa- Jr a des°- 
tion we ask from the child physical expression, be- 
cause that is his absorbing interest, and through it 
his mental interest is awakened. 

HEALTH AND EDUCATION 

The health of the children is the note we are 
sounding, and normal life and growth generally g T °J™ t ^ 
mean healthy life. Most of our schools work along mear >s 
lines distinctly opposed to this. They place the child life 
under abnormal conditions, in confining him in the 
classroom, out of the air and sunshine which are 
his by right, by seating him at a desk which often 
cramps or strains his muscles, and by restricting his 
motions to set exercises allowed only at stated inter- 
vals, with no regard to his inclination, and suggested 
by a mechanical power quite outside his conscious- 
ness. With this utter lack of spontaneity they de- demands 
mand irrational results, and in their disregard of 
hygienic principles they defeat their own ends, for 
the most rapid mental progress is made when bodily 
health is assured. 

The health of the child ought to be benefited in 
consequence of his attendance at school. If we find 
that this is not true, our criticism of school methods 
is justifiable. 

Some of the diseases which school-children are Diseases 
found suffering from are affections of the eyes, bad condi- 
spinal curvature, nervousness, rickets, chorea, catarrh. school*' 



What 
statistics 



332 CARE OF CHILDREN 

headache, tuberculosis, indigestion, and constipation. 
All of these are aggravated at least by unhygienic 
conditions which are existent in the common schools. 
Nearsightedness and other such abnormalities are 
very prevalent among school-children, and statistics 
show that nearsightedness progresses with the grades 
till in the highest classes more than one-half the 
pupils have defective vision. 

The city schools show a higher percentage than 
those in the small towns, and among the pupils in 
show buildings of recent model construction in regard to 
lighting the proportion is smaller. This is the most 
eloquent argument against the crowded, ill-lighted 
schoolroom, and yet in the face of such proved facts 
we find classrooms in large cities which have to de- 
pend largely upon artificial light. 
School Unhygienic school furniture is chiefly respon- 

furniture sible for spinal curvature, which is appallingly com- 

responsible *■**•*■, <-> • • 

for spinal mon among school-children. Sometimes it is not 
curvature no ti ceaD l e) but often it increases till it is a very 
apparent deformity. Between seven and fourteen 
the largest percentage of this disease is found, prob- 
ably because before that a child is not confined so 
closely at school. 

It is entirely unnatural for children to remain 

for any length of time in the sitting position. The 

bones are not yet firm, and the muscles are weak. 

School hours are unfortunately long, and the bones 

of the spinal column yield in time to the force of 

gravity, even if a strained position at the desk has 

not played its part in causing a curvature. 

Bones of The ossification of the bones is not complete 

children until the age of twenty-five, and until thirteen or 

ou'm 101 " fourteen it; is possible to make definite changes in 

ossified their position by judicious or injudicious treatment. 



FOOD AND EXERCISE 333 

Nervousness is marked in school-children, and 
manifests itself in various forms, but is increased 
by the pressure which is applied in school work, by Results of 
the worry over examinations, and often by the nerv- impure a ir 
ous tension of the instructors, who must feel the 
stress in their turn. Rickets, tuberculosis, catarrh, 
and headache may not necessarily be brought about 
by impure air, but it certainly tends to increase any 
of those troubles, and the sitting posture, particu- 
larly if the back is not held erect, has its effect 
if there is any predisposition to rickets or tuber- 
culosis. 

Two essentials in any lung trouble are that the 
lungs should have air rich in oxygen and that they ^f^g 3153 
should expand fully. When the shoulders droop or trou bies 
the body is held in a cramped position at an ill-made 
desk, the lungs are compressed and the air cells can 
not do their work. 

The special causes of chorea have been discussed. 
The fatigue of muscles forced to the strained effort Fati f ue 

# p in chorea 

of maintaining one position, or of concentrated at- 
tention to circumscribed movements, as in writing, 
probably has much to do with increasing the severity 
of the attack, especially as the nature of the trouble 
is often not recognized and more pressure rather 
than less is applied. 

The time for meals is shortened, eating is too 
often a hurried, perfunctory task, and indigestion 
results. The sedentary life increases the difficulty, suits of a 
and adds the grave one of constipation. The rush of s "hoo! 
getting off to school in the morning, the restraint llfe 
during working hours, also have their effect, for 
habits of regularity are difficult to form under these 
conditions, and if the bowels are neglected results 
are disastrous. The old English philosopher, John 



334 CARE OF CHILDREN 

Locke, in touching this point in his famous work on 
education, advises a regular hour at which a child 
should invariably "solicit nature" — this hour being 
kept to with inflexible regularity. 

"There is reason to suspect," says Locke, "that 
Locke's children being: usually intent on their plav and verv 

famous r i • 

remedy heedless of anything else, often let pass those motions 
tiveness °f Nature when she calls them but gently ; and so 
they, neglecting the seasonable offers, do by degrees 
bring themselves into an habitual costiveness." The 
remedy suggested is the holding the child daily 
to an hour for action, and thus establishing the 
regularity in which Nature rejoices in all her 
works. 

We do not mean that these evils are inevitable 
in the school life of a child, but it is true that a 
general survey and examination of the health of 
Schools pupils shows that a surprising proportion has chronic 
signs of ew disease of more or less serious nature, that head- 
advance acnes are universal, that, in short, Civilization has no 
advance to show as regards the physical condition 
of her children. The Spartans gave their youth first 
and foremost the gift of vigorous bodies, trained by 
endurance to perfect control, to a thorough enjoy- 
ment of life through spontaneous self-activities and 
expression. When our system of education accom- 
plishes that for the physical, it will be time to point 
with pride to the gain in mental development of the 
children under its guardianship. 

The nervous breakdown in college dates back to 
pressure in the elementary school, systematic pres- 
sure, persistently applied. If all schools were like 
the worst, the evils would be such crying ones 
that parents would demand a change, and it would 
come. 



FOOD AND EXERCISE 335 

The number of schools of the better sort is in- 
creasing, and as the experimentation succeeds the 
popular prejudice against learning made joyous will 
disappear, and the normal training of children will sor t f 
not be limited to the few, but will be the natural ?^° e ^ sin 
heritage of all. 



IV 



POINTS ON HYGIENE 



Toughening "—Baths— The Teeth— Footwear— Dress 



Cold baths 
and cold 
rooms may 
tend to 
make chil- 
dren less 
resistant 
to disease 



"TOUGHENING" 

THE process of "toughening children" is a very 
mistaken one, failing utterly of its purpose in 
nearly all cases. Generalization in the treatment of 
children is not rational, and cold baths and exposure 
to all kinds of weather indoors and out are not uni- 
versally helpful. 

The cold bathing, unless a child has vigorous, 
abounding health and a nervous system that enjoys 
the shock, tends to debilitate rather than to stimulate, 
and with increased nervousness come loss of appe- 
tite and sleeplessness. 

Exposure in cold sleeping-rooms, instead of 
making a very little baby less liable to throat and 
chest affections, often leaves him more susceptible to 
colds, catarrh, and sore throat, and this susceptibility 
increases the severity of many of the infectious dis- 
eases of childhood. 

In exceedingly inclement weather very little -chil- 
dren should not be taken out. The air in their 
sleeping-rooms must be fresh, and they must be so 
ventilated that it is changing constantly, but widely 
opened windows and atmosphere perceptibly chilled 
are conditions which are likely to make children less 
resistant rather than more so. 

The extreme is quite as much to be condemned. 
(336) 



POINTS ON HYGIENE 337 

To keep a human being protected like a hothouse 
flower indoors, to wrap the throat and indeed the Weaken- 
whole body in fur, and to make impossible free exer- too much 
cise out in the air is to make sure a weakening of protectl0n 
vitality which leads to practically the same results, 
along perhaps more direct paths. The individual 
must be considered, and the process of hardening 
must be gradually established, with little attempt at 
radicalism till after the child is capable of indepen- 
dent motion. 

BATHS 

Bathing in disease, and its relation to the func- 
tions of the skin, have been described. Its impor- The daily 
tance in health is no less to be considered. The daily 
bath ought to be as much a part of the day's routine 
as the care of the hair, and children will so regard 
it if it is given them as regularly after they are 
grown as when they are babies. 

In summer a child who has been vigorously play- 
ing all day needs a warm cleansing bath at night, The bath 
because the perspiration has been secreted so plenti- s i e e ^, re 
fully and the oil-glands have also poured out their 
fluid in abundance. This has been mixed with the 
dust, which collects upon the surface of the body, 
sometimes in a perceptible amount, but always enough 
to need removal with warm water and soap. 

A bath should not be given immediately after a 
meal, but if children have their suppers at five or 
half-past, there is time for the little frolic which 
always seems to have its place before bedtime, and 
the bath will quiet the nerves and relax the muscles 
for restful sleep. 

In the winter the bath is useful to stimulate the 
circulation, to increase the heat of the body, and to jointer 
render the child, if possible, less susceptible to cold. 
i5 Vol. 3 



338 CARE OF CHILDREN 

For this reason the cool or tepid plunge in the morn- 
ing is of especial value. If he is of normal health, 
and is gradually accustomed to the cool water, he 
will learn to like the shock and will especially enjoy 
the glow and tingling warmth of the reaction. A 
cold bath must be given with care, for unless a child 
is very vigorous the shock will be too great, and no 
good will result. 

Children enjoy the feeling of the air on their 
bodies, and if the household is one which will admit 
bath of it, they should be given the chance each day for a 

brisk run about through the rooms of comparatively 
even temperature, without the restraint of clothes. 
As long as children are unconscious of their bodies 
there is no reason why they should not have that 
freedom, and it is made impossible by remarks which 
they feel though they do not understand. 

Children's scalps collect dust and their hair re- 
and q thor- quires shampooing much more often than that of 
pooing ham " adults. If the hair is short it is very easily kept 
clean, but it must not be neglected, because an accu- 
mulation of dirt may lead to disease, and if a little 
borax or alcohol is added to the last rinsing water 
the hair dries quickly and there will be no danger of 
catching cold. 

THE TEETH 

Teething usually begins at six months. It may 
if teething be delayed until the second year, with no other sign of 
consider* 1 arrested development, and the order in which the teeth 
the , chil 4' s come may vary in every way without any indication of 
digestion illness, and with no bad effects upon the system. 

Parents, however, should be sure that the food 
contains the proper elements for the nourishment of 
the child, and that it is being properly digested. The 
food is often responsible for disorders that are at- 



POINTS ON HYGIENE 339 

tributed to teething. If the teeth are delayed in their 
appearance, or if the gum is unusually hard and 
fibrous, so that they have unusual difficulty in pierc- 
ing it, there will be nervous irritation and there may 
be functional disorders, but if the food is suitable 
the symptoms are not the same as those produced by 
intestinal trouble. 

The diarrhoea that is sometimes caused by diffi- 
cult dentition can be distinguished from that brought _ 

° ° Symptoms 

about by intestinal irritation. In difficult dentition in difficult 
there will be great fretfulness and acute pain, with 
spasmodic movements of the muscles of the face, the 
gums will be swollen and red, and the appetite will 
be variable. The child troubled with indigestion wishes 
to bite and chew anything put into the mouth. One 
suffering with pain from swollen gums will not bring 
them together upon anything. If the teeth are re- 
sponsible for the condition, lancing the gums will 
give immediate relief. 

The teeth appear in groups, making a division 
in time which allows a rest between their appear- 
ances. Changes in food, weaning, or any such break f tefth UpS 
in regularity may best be arranged for one of these 
periods of rest. 

A table which may be accepted as representing 
the usual order is as follows : 

I. 6 — 8 months 2 middle lower incisors 

II. S — io months 4 upper incisors 

ttt to r. rv,™ Tr1 c j 4 lateral lower incisors 

III. 12-14 months J J first molars 

IV. 18 — 20 months 4 canines 

V. 28—32 months 4 second molars 

The first set of teeth numbers twenty. The four 
middle teeth in both jaws are called incisors, the next f U ?he r 
four on either side the incisors, both upper and lower, first set 
are canines. The remaining eight are molars. 



340 CARE OF CHILDREN 

The importance of care of the temporary teeth 

is not appreciated, and they are too often allowed to 

become decayed, and thus of no use to the child. The 

what evil evils of this are twofold. The presence of a decayed 

tooth aye tooth in the mouth means that the micro-organisms 

may do w hich cause the decay are spreading their poison to 

other teeth, through the roots to the permanent tooth 

which is to take its place, and leaving an effect upon 

the general digestive tract. In the second place a 

tooth which contains a cavity is incapacitated from 

its share in mastication. 

A child will adjust himself to conditions if a 
How bad remedy for them is not forthcoming, so that often 
teeth affect ne w jh ce ase complaints of an aching- tooth because 

a child s r ° 

mastication he has adopted the plan of giving it no work to do. 
If there are decayed teeth on both sides of the mouth 
this frequently means that food is swallowed prac- 
tically without mastication. Habit is strong in all 
the acts of our daily life, and such a one established 
would inevitably lead to imperfect digestion. 

The teeth are intended for use, and the mastica- 
tion of solid food keeps them in a healthy condition, 
and is one of the best helps toward cleaning them. 

The pain of decayed teeth also affects the nerves 
in a way that is exceedingly bad for a child's devel- 
opment. 

If the temporary teeth are decayed and neglected 
the permanent ones which follow are almost sure "to 

Care 

of the be imperfect. When a tooth is lost the gum shrinks 
first set an( j t ^ e S p ace tnat t ^ e secon( i tooth is to occupy 

changes in shape. It is then very likely to be out of 
place, and will very probably crowd the other teeth. 
The greater probability is that the decay of the first 
tooth is communicated to the second, and to its neigh- 
bors as well. 



POINTS ON HYGIENE 341 

Children should have early instruction in the 
care of the teeth. While they are very young they The sort of 
can be taught to rinse the mouth thoroughly, and use and 
the use of the toothbrush will interest them, in the usTit° 
beginning at least, because of its novelty and as being 
a sign manual of increasing ability. Such a brush 
as that called the prophylactic is the most sanitary 
and effective. Its bristles are of unequal lengths, and 
a tuft of longer ones at one end penetrates well be- 
hind and between the teeth. The curved shape of the 
handle makes it fit the jaw better than the straight 
brush. 

The toothbrush should be used over the surface 
of the teeth with a downward motion on the upper J^ u e s iJ 00th " 
teeth and an upward motion on the lower teeth, which 
causes the bristles to pass between them. The food 
arid the motion of the lips, tongue, and cheeks over 
the surface of the teeth prevents the accumulation 
of organic substances and the development of micro- 
organisms, and it is between the teeth that decay 
begins. Dental floss may be used additionally to P ental 

J J floss versus 

make sure that no food has lodged there, and is much wooden 
better than wooden toothpicks, which are very liable 
to splinter and leave behind more harm than they 
remove. 

A tooth-powder is useful, though not absolutely 
essential, if the cleansing process is regularly and 
carefully carried on. A very good formula for powder 
powder to be made in the household is as follows : 
One part white castile soap, two parts precipitated 
chalk, with powdered orrisroot to flavor it. Shave 
the soap in thin flakes, and dry it for a day or two 
before using. Proportions and flavoring can be 
varied. 

Children can be accustomed to visits to the 



342 



CARE OF CHILDREN 



The teeth 
should be 
regularly 
examined 
by a good 
dentist 



The per- 
manent 
teeth 



When a 

tooth 

aches 



Care of 
the teeth 



dentist's so that there need not be that frantic terror 
at the thought that often keeps a parent from giving 
them the proper care in that regard. Too often 
stories of agonies suffered are retailed to their ears. 
This should never be allowed, and the regular visits 
for examination will remove many of the alarms. 

The permanent teeth number thirty-two. At 
about six years of age four of these teeth, the molars, 
appear just behind the temporary molars. Four more 
come about six years later, still further back on the 
jaw, and the eight bicuspids take the place of the 
eight temporary molars. This early appearance of 
the first permanent teeth should be understood, for 
often it is considered that they are first teeth, and 
they are allowed to decay. 

When the pain in a tooth is caused by the pres- 
ence of a foreign body on a live pulp, removal of 
the cause relieves the pain, but when there seems to 
be no especial reason for it the treatment is different. 
The cavity should be carefully washed out with tepid 
water or with water and peroxide of hydrogen in 
equal parts, dried, with absorbent cotton, and a tiny 
bit of the cotton, soaked in equal parts of carbolic 
acid and oil of cloves, placed in the cavity. A five 
per cent solution of carbolic should be used, and care 
must be taken not to get it on the surrounding gum, 
since it will be liable to burn any tissue it touches. 
Compound tincture of benzoin applied in the same 
way may also relieve. 

The necessity of immediate care of diseased teeth 
can not be too strongly emphasized. If the teeth are 
properly brushed as they are coming in, the loss of 
teeth in adult life is very unusual. "Gum-boils," ab- 
scesses, and decay of teeth, aside from the pain, 
which must be nervously debilitating, are constantly 



POINTS ON HYGIENE 343 

introducing poisons into the system, which negative 
any measures taken toward hygiene of the digestive 
organs, and imperfect digestion is incompatible with 
normal development. 

FOOTWEAR 

Troubles with the feet, either from corns, from 
tenderness in the soles, or from difficulty in getting Careful 
ig shoes, are common enough among 



attention 

comfortablv fitting shoes, are common enough among to the 



adults, so that the need of careful attention to the feet ^f 
feet in childhood must be recognized. We have spoken children 
of the cartilaginous state of the bones in infancy. 
That condition and the fact that the foot and ankle 
are composed of a number of very small bones make 
it possible to compress the feet in childhood and 
cause them to grow misshapen or even deformed, 
without severe pain. 

The fad of bare feet and legs had for its inspira- 
tion the reasonable revolt from the unhygienic treat- 
ment that childhood had received in this regard, but 
it was extreme, and may be modified on more rational 
lines. The freedom is admirable, but the exposure 
is not always wise. Warmth of the extremities is 
what we emphasize as necessary to protect a baby 
from colds, and the intestinal disorders which so 
often follow. 

The first shoes should be soft kid moccasins, made 
of ooze or undressed kid, with no stiffness in the ^ g first 
sole, and fastened with a soft lacing up the front. 
These are sold by any firm dealing in children's 
furnishings, but are much more cheaply made at 
home. To make them is very pretty work, and the 
pattern can be enlarged as the foot grows, so that 
there need be no danger of pinching the feet. 

A child can often wear these from the time he 



344 CARE OF CHILDREN 

begins to walk until he is three years old, a stouter 
kid being chosen as he becomes more vigorous. They 
ensure an absolutely natural position of the foot, 
quite as truly as no shoe at all, and they offer ample 
Need of a protection from cold and dampness on the one hand, 

moccasin , r , ,. , , , . , 

protection and irom the dirt and sharp objects that experience 
to the feet nas p rovec [ are a source f danger to children allowed 
to go with legs and feet uncovered. The baby who 
is only creeping, or whose walks are confined to his 
nursery, does not run the second risk, but older chil- 
dren do, and cuts from sharp stones or pieces of glass, 
or the more dangerous wounds from rusty nails have 
been sources of such serious illness that the protec- 
tion of feet and legs ought to be appreciated. 

Almost every child when he begins to stand or 
The nat- walk will hold the feet either at a direct right angle, 
urai posi- f rom a ii ne drawn down the front of the leer, or 

tion of & ' 

the feet slightly turned in. The prints of his feet show a 
series of almost parallel lines. It is only when he 
has grown considerably older that he adopts the 
"toeing-out" position, which he acquires either from 
imitation or by definite instruction. The natural 
position should not be interfered with. He may ac- 

Values 

of the quire habits, like standing with the weight resting 
posi ion on one j e g on \y } or w jth one foot turned over, which 
certainly requires correction, but the straight posi- 
tion of the foot is now believed to give better bal- 
ance to the body, a firmer contact with the ground, 
and less strain on the muscles and bones composing 
foot and ankle. 

The small bones are put together in such a way 

that they form the arch which gives the foot its 

ing 6 of f the grace. An habitually false position continually kept 

the h foot U P weakens the muscles and ligaments which hold 

the bones in place, and the arch breaks down, causing 



POINTS ON HYGIENE 345 

the foot to rest evenly on the ground, depriving the 
carriage of its elasticity and occasioning intense 
pain during the gradual sinking of the arch, and 
afterward when the weight of the body is borne for 
any length of time. 

This is a condition known as flatfoot, and must 
be corrected by metal plates worn in the shoes, to 
support the broken arch in its original position. With 
children the condition is very unusual, and if they 
were encouraged to maintain the normal position 
of the feet rather than being instructed and sometimes • 
forced to walk in the more conventional way, there 
would be fewer adults with weakness of this kind. 

When the time comes for the child to put on 
stouter shoes, especial care should be taken to get shoe should 
those that follow as closely as possible the outlines the outline 
of his foot. If he has enjoyed the freedom of moc- of the foot 
casins for two or three years he. will rebel at any 
approach at undue compression, and this early edu- 
cation, especially if his somewhat radical views on 
the subject of footwear are respected by the parents 
who provide and choose his clothing, will probably 
make him always regard comfort before fashion, and 
will save him from many of the adult infirmities. 

Stout soles, flexible leather, and spring heels are 
three other essentials, and when the heel is changed Essentials 

of a shoe 

it should be by the addition of a very few lifts at 
a time, should never be high, and should be as a sup- 
port at the extreme back of the sole, not sloping in 
toward the middle of the foot. 

DRESS 

We have emphasized the need of simplicity in the 
clothing of the baby, and of giving him entire free- Need of 
dom of movement so that he will not feel the restric- simp iaty 



346 CARE OF CHILDREN 

tions of tight bands and heavy skirts. These needs 
increase rather than otherwise with the growing 
child. 

There is a temptation to regard a child, particu- 
larly a girl, in the light of a doll, and to try the effect 
of frills and ribbons upon her, losing sight of the 
question of her right in the matter. 

Whatever the sex, . the child should be dressed 
a child with regard to his activities, not to his capacity for 
dressed decoration. When a baby begins to crawl about 

regard on tne ^ oor or m ms "P en >" ne can ^ e made more 
to his comfortable and his clothing- will be protected if he 

activities ... ° 

is put into "creepers." These are very full, baggy 
"Creepers" trousers, gathered around the legs, and extending 
to the armpits. 

Pinafores may be made for the same purpose, 
with a draw-string in the hem at the bottom. These 
serve as a protection to the skirts, which are safely 
tucked up inside, but the question is whether the 
little dresses themselves might not be made of col- 
ored stuff after the trousers pattern, thus avoiding 
the extra bulk and clumsiness. 

During a baby's waking hours he is always hap- 
piest when he is carrying on investigations in the 
dirt or about the floor, which even in a model house 
can not be free from dust. If he is dressed properly 
Proper he can be allowed much more freedom both summer 
allows and winter, and though he may not be such a source 
na e turai by °^ gratification to the aesthetic sense, his sturdiness, 
activities healthy color, and growing strength will soon con- 
vince any one that the beauty of health is greater 
than the combination of dainty, spotless skirts and 
fluffy hats, with the delicacy of skin which is due 
to shelter from breezes and sunshine. When laundry 
is no consideration the colors of wash suits may, of 



POINTS ON HYGIENE 347 

course, be lighter, and white may be worn and is 
rather more satisfactory than the delicate shades, 
which soil almost as quickly, and fade in washing. 

We make the mistake often of burdening a child Do not 

. , iii-ii r burden the 

with too much clothing when the same amount of child with 
warmth could be gained with less weight and clum- clot es 
siness. 

A perfectly comfortable and suitable set of gar- 
ments for children to wear may consist of a com- A su j ta bie 
bination suit, or shirt and drawers, of cotton jersey dress 
in summer and of woolen or part woolen in winter, 
a pair of full bloomers or knickerbockers coming 
just to the knee, and made on a cotton waist, and a 
Russian blouse of the same material as the knicker- 
bockers. In winter the combination suit should be 
high in the neck, long sleeved, and should reach to 
the ankles. In spring one of medium weight is 
needed and if the summers are cool or if the child 
is delicate they may be suitable for the entire season. 
Otherwise a third set, light in weight, low-necked, 
short-sleeved, and knee length, will be necessary. 

The knickerbockers and dress are made of cot- 
ton or linen in summer, and of wool in winter, and 
the long coat, made of warm stuff, and interlined 
for the coldest weather, supplies the needed protec- 
tion. 

This dress, with modifications, is equally suitable 
for boys or girls. There are no extra garments, the The suit 
task of dressing and undressing is made very simple, boys and 
and no style of costume is more becoming to the gir s 
grace of a childish figure than the long simple lines 
of the Russian blouse. It lends itself very effectively 
to artistic ornamentation, though frills, bows of rib- 
bon, and lace are eliminated by its severity. 

For a girl the skirt of the blouse reaches below 



348 CARE OF CHILDREN 

Variation the knickerbockers, concealing them entirely. A 
boy's is shorter, coming down about halfway between 
the knees and the waist. 

The difference between their dress usually makes 

Allowing necessary a difference in pursuits, for which there 

activity * s no indication so far as good sense and reason are 

and health concerned. A girl enjoys freedom of limb, activity 

of exercise, and life in the open as well as any other 

healthy little animal, and too often she is forced to 

follow her natural instincts only at the expense of 

her clothes, and a reputation for gentleness, which 

she may not in her heart desire, but which is held 

up before her as a model for her sex. 

The association of children should be natural and 

free, and sexual differences should be emphasized 

Do not as little as possible, either by their dress or their 

sScna1 Slze manners. In this way unnatural precocity will be 

differences SU pp r essed, and consciousness of sexual questions, 

and curiosity concerning them will be delayed till 

development makes explanation necessary. 



V 

DISORDERS OF CHILDREN 



Symptoms of Illness— Colic— Jaundice— Inflammation of the Eyes— Thrush— 
Diarrhoea, Constipation, Convulsions— Teething— Milk Crust— Eruptive 
Disorders— Hives— Prickly Heat— Ringworm— Croup— Rickets— St. Vitus's 
Dance 



T 



SYMPTOMS OF ILLNESS 

HE observation of symptoms in children's dis- 
eases requires much more skill than in the ail- 
ments of adults. Even when a child is old enough to 
make complaints, he often does not locate or describe 
pain at all accurately, and in infancy we must depend 
almost altogether on objective or involuntary signs of 
distress. 

We have spoken of the character of the cry. When 
the pain is in the abdomen, the cry will be long and Signs of 
loud, and tears will be shed. The muscles of the ab- in the 
domen will be relieved of strain by the position of the abdomen 
legs, which will be drawn up close to the body. As 
the pain subsides, the loud cry will change to deep sob- 
bing. 

When the chest is involved, the cry is sharp and 
short, and the breathing will be rapid and labored, in the 

If a child rolls his head from side to side, there is head,' ear 
suspicion of brain trouble. The cry in this case may 
be a sharp scream, or a low moaning. If he has ear- 
ache, he generally rubs the affected side with his hand, 
and sleeps with it turned down on the pillow. 

Restlessness during sleep, the position he takes 
when at rest, the character of the stool, the breathing, 

(349) 



350 CARE OF CHILDREN 

the temperature, and the pulse should be noted and 
reported. 

The pulse can be most accurately taken when the 

The pulse child is asleep. In health it should be between ninety 

and one hundred, but it varies so very easily, and is 

influenced by such trivial causes, that more dependence 

is put on the temperature as a guide in sickness. 

If a child shows any symptoms of illness we look 
Observing at the tongue, we take the temperature, and ascertain 
symptoms the condition of the bowels. The tongue should be 
clear and moist, the temperature should be in the near 
neighborhood of 98. 6° F., and the bowels should be 
moving easily once or twice a day — the movements 
should show no undigested food, should be pasty in ap- 
pearance, and yellow or light brown in color. If we 
find these three points satisfactory, we may feel as- 
sured that the disturbance is not a serious one. 

If the child seems to be in pain, and has a rise of 
Examining temperature, it is always wise to examine the throat. 
Many of the children's diseases begin with throat 
trouble, and little children rarely make any complaint 
that would lead one to suspect where the difficulty 
lies. 

When a child first shows any signs of illness it is 
Value of always wise to put him in a warm bath. He should 
bath remain in it for about five minutes. That will tend to 

bring out the rash if it is one of the eruptive diseases, 
to reduce temperature, and to soothe the child so- that 
he can sleep. The room should be warm and the bath 
should be given with as little disturbance as possible in 
the preparation. 

It is always safe to give some mild laxative, and 
oif ia°xa^ e olive oil is as simple a remedy as can be tried. The 
tlve dose is from twenty drops to a teaspoon of it. 

If there are other children in the family, it is safer 



DISORDERS OF CHILDREN 351 

to keep the baby by himself until one is sure that the 
disease is not contagious. 

If the baby is being fed on the bottle, the food may 
be diluted a little — one-half the strength if the stomach Food and 
is disordered. If the temperature is high, he should be 
given plenty of pure boiled water to drink. 

Xo medication beyond the laxative should be given 
without the doctor's orders. Many of the various dis- 
orders that afflict babies can be treated without a doc- 
tor, but mothers must understand what symptoms are 
alarming, and which are typical of the more serious 
diseases. 

COLIC 

One of the earlier of baby ills is colic. If it is 
persistent, it can often be traced to the food or to a Remedies 
disordered condition in the mother, when the baby is 
nursing. Cold hands and feet are sometimes responsi- 
ble for it, and heat, applied to the body outside, and by 
warm water, or a little peppermint internally is the best 
remedy. Colic is caused by an accumulation of gas in 
the intestines, so the logical course is to set it free, and 
to cause it to pass downward, and out if possible. 

Paregoric or soothing syrup of any kind is partic- Do not 
ularly harmful, since it simply dulls the consciousness soothing 
of pain by the action of the opiate, which is contained p^"^^ 
in almost any such preparation. 

JAUNDICE 

The jaundice of the new-born is rarely at all alarm- 
ing. It occurs during the first and second weeks of in- 
fant life. The skin and the whites of the eyes look very 
yellow, and the urine is highly colored. It is some- 
times caused or increased by a tight bandage, and 
after that is loosened, the symptoms may entirely dis- 



352 CARE OF CHILDREN 

Remedies appear. If it persists, especially if it seems to affect 

jaundice the general health, a physician will prescribe medicine 

to stimulate the secretion of bile and to clear out the 

intestines. The bowels should always be kept freely 

opened, and often the use of olive oil will be sufficient. 

INFLAMMATION OF THE EYES 

The routine care of the eyes has been described. 

The discharge from the vagina of the mother at 

the time of birth may infect the baby's eyes, so that 

the inflammation appears shortly after birth. For this 

The reason, the greatest care should be taken to bathe the 

at birth of eyes with boric solution before they are opened at all. 

solution They may be infected at a later time by carelessness in 

handling or by coming in contact with a towel or 

handkerchief that has been used by a person suffering 

from some disease. The treatment in any case is the 

same. 

In the beginning, a redness of the eyelid, with a 
slight swelling, is remarked. There is also a discharge 
inflamma- which tends to prevent the eyes from opening. All 
tion of the these symptoms rapidly become worse, till the eye is 
and y it s eyeS completely closed, the lining becoming so swollen that 
danger jj- turns completely out over the lid, if the latter is 
drawn down. 

It is an extremely dangerous condition, if allowed 
to persist, for the discharge is very poisonous, and the 
cornea, or covering of the eyeball, may become ulcer- 
ated and destroyed, when, of course, the disease would 
penetrate to the inner chambers of the eye, and the 
sight would be destroyed. 

A physician should be consulted, unless the redness 
yields at once to treatment. If the trouble appears 
in a new-born baby, the doctor should be at once ad- 
vised of it. 



DISORDERS OF CHILDREN 353 

Thorough irrigation of the eye is necessary. This irrigat- 
should be done with a boric solution, and may have to 
be repeated every fifteen minutes. It must be done 
often enough to keep the eye entirely free from dis- 
charge. The lids are to be separated, and the solu- 
tion, warmed to body heat, allowed to flow plentifully 
over the ball of the eye. 

The same precautions which are to be given in 
the ordinary care of the eyes are to be observed here. Precau- 
The solution must flow toward the outer angle of the 
eye, so that there is no chance of carrying the infec- 
tion from one eye to the other. Cloths or compresses 
must be burned. 

Basins should be boiled or burned out with alcohol Disinfec- 
after use, and great care must be taken in washing 
the hands at once after giving the treatment. 

The baby should never occupy the same bed with 
other children, and he ought to be completely isolated. 
The doctor will probably order compresses wrung out 
of ice-water, and applied constantly over the eyes. 

Danger lies in the neglect of such a condition as 
this. It is estimated that no less than one-fourth of the Danger 
cases of blindness in adults is traceable to this disease, neglect 
It is most common among persons who live in unsani- ^nesT 
tary surroundings and who are careless about cleanli- 
ness, and the commonest laws of hygiene. 

THRUSH 

Thrush or sprue is a disease of the digestive tract. 

It is caused by improper food, or by neglect of the 
mouth, which should be washed frequently during the How 
day. The particles of milk which remain in the mouth D r 0U ght S 
after feeding decompose and cause tiny ulcers to form. about 
These spread into patches, and in severe cases extend 
all over the mouth, and even into the stomach. The 



354 



CARE OF CHILDREN 



The 
remedy 



throat and mouth may become so tender that swallow- 
ing is almost impossible, or the irritation may cause a 
diarrhoea, which is very exhausting. 

A wash of borax, or one made of a teaspoon of 
baking soda in a cup of water, is usually the remedy 
given. The mouth should be washed out very gently, 
as there is danger of irritating the delicate lining mem- 
brane. It is perhaps better to apply the solution with 
a soft camel's-hair brush. 

Prevention is much simpler than cure, and the ut- 
Prevention most care should be taken in the preparation of food, 
and in the care of utensils, in order to guard against 
such possibility of disease. 

There are normally in a baby's mouth tiny white 
spots, which are called "pearls." These do not indicate 
disease, and should not be rubbed with any force in 
cleaning the mouth. After a little observation, it will 
not be difficult to distinguish the difference. 

Thrush is more likely to occur in a child whose re- 
sistance is weakened by some exhausting disease. 
There is no need of its appearance in a healthy child, 
if he receives proper care. 



"Pearls" 



What 

diarrhoea 

indicates 



The first 
treatment 



DIARRHCEA 

Diarrhoea is caused by some irritating substance 
which is present in the intestines. 

With the bottle-fed baby, who is most subject to 
the trouble, it means too often neglect in the care of 
bottles or nipples, or carelessness in the choice of the 
milk. With older children it is generally due to the 
eating of unripe or decayed fruit, or to an excess of 
green or tainted vegetables. 

Our first task is to get rid of the irritating poison, 
and there are certain things that the mother can do 
promptly before a physician comes. A teaspoon of 



DISORDERS OF CHILDREN 355 

castor oil will purge the bowels, and the digestive ap- 
paratus may be relieved of some of its work by stop- 
ping all the milk for twenty-four hours at least. " 

Barley water, wheat gruel, or mutton broth and 
barlev water, in equal parts, may be substituted. The Substitutes 
frequent loose movements are taking a great deal ot 
water from the system, so this should be supplied as 
far as possible, by giving as much water as he will 
drink. It should be boiled and cooled. 

There is often vomiting with the diarrhoea, when 
it may be impossible for the stomach to dispose of any Egg-water 
food at all. In that case, egg or albumen water, as 
it is called, will furnish a little nourishment, and can 
generally be retained. This can not be relied upon 
for any length of time, but is better than an absolute 
fast, till the trouble is under control. The egg-water 
is given in small amounts, sometimes a teaspoon at 
a time, and at intervals of half an hour, or from two 
to three ounces every two hours. 

If the trouble seems to be chiefly in the stomach, 
it may not be necessary to eliminate the milk entirely Peptoniz- 
from the diet. It may instead be predigested by pep- p n r |5ge S t- 
tonizing. As has been stated in a previous chapter, ing foods 
the peptonizing must not be continued, as it leaves too 
little work for the stomach to do. Cereo is a prepara- 
tion which predigests starchy foods, as the peptoniz- 
ing powder does milk, and this can be added to gruel, 
leaving out the sugar in this case, and making it double 
the strength. Cereo comes in bottles, with directions 
for its use, and can be obtained in any drug-store. 

The movements of the bowels are not only watery 
and frequent, but they are generally of a bright green Symptoms 
color, and contain small curds, showing that the milk require 
is not being taken into the system, but is passing ^nh^miik 
through the canal undigested, and is acting only as an 



356 



CARE OF CHILDREN 



Summer 
complaint 
and 
dysentery 



irritant. This condition is an indication for stopping 
all the milk for twenty-four hours at least, to relieve 
the digestive apparatus of some of its work. 

The diarrhoea may indicate a simple temporary 
derangement of the bowels, or it may accompany the 
dreaded summer complaint, when the stomach as well 
is involved, or it may take the form of dysentery, when 
blood and mucus appear in the stool. The two latter 
diseases are very dangerous, because if long continued 
the system becomes so weakened that the strength is 
spent and the child does not rally, even if the first cause 
can be removed. If the cathartic does not accomplish 
the desired result, the doctor will probably order rectal 
irrigation with a salt solution. He will give the mother 
directions and assistance for the first time at least, and 
usually it should not be done without his orders. 

There are times, however, when a woman must act 
upon her own responsibility in such matters, and if 
she understands the use of the syringe and realizes the 
need of care, there is little danger of harm. The ap- 
paratus for flushing a baby's bowels is a fountain 
syringe, a soft rubber catheter, one that will fit over 
the smallest enema point, and a basin to receive the 
water as it flows out. 

The solution is boiled water, which has been cooled 
Giving to about -100° F., to which is added one teaspoon of 
In 6 enema table-salt to each pint. Put the baby on a table, with 
a thick pad and a rubber under him. His clothes 
should be turned up, so that there is no danger of' their 
getting wet, and he is drawn down so that the buttocks 
rest on the edge of the table. A basin is placed just 
underneath, close enough to receive the water^ and 
the syringe is hung about three feet above. 

The directions for enemata and rectal irrigation in 
Part II are to be followed here, but with a baby the in- 



Using the 

syringe 



DISORDERS OF CHILDREN 357 

sertion of the oiled catheter must be clone with extreme Especial 
gentleness, because of the danger of puncturing the precau- 
delicate intestine, It should never be forcibly pushed t,on 
up, but if it is done slowly, waiting till the bowel re- 
lapses from time to time, it can gradually be intro- 
duced nearly its entire length. 

The water is first turned on when the catheter is 
inserted about two inches into the rectum, in order 
to clear out the gas, and the accumulation in the 
lower bowel. After the water comes away clear, 
which it will generally do while the second pint 
is being given, the enema point is detached from the 
catheter, and the abdomen is gently kneaded with the 
hand to get rid of the remaining fluid. 

This irrigation may be ordered twice a day, and is 
valuable, not only because it cleanses the intestine of Effect 
the irritating poison which it contains, but because it treatment 
supplies a fluid to replace what is lost by the watery 
evacuations, and because the salt stimulates the tissues, 
and reinforces the blood supply. It should not be con- 
tinued more than a few days v/ithout a doctor's advice, 
because in cases of extreme prostration the exertion 
may outweigh the results for good. 

The baby's bath should be continued through any 
illness, unless forbidden by the physician. It should, Added 
however, be given under a blanket, and the child should daifybath 
be moved as little as possible. When the diarrhoea 
is accompanied by extreme emaciation, it is sometimes 
considered that rubbing the child with oil supplements 
the feedings. 

Olive oil may be used, and it should be rubbed in 
thoroughly, particularly over the abdomen. It was The oil 
once believed that the skin possessed to a considerable at 
degree the property of absorption, and medication was 
often given in that way. The importance of this func- 



358 CARE OF CHILDREN 

tion was probably exaggerated, but the good effects of 
rubbing are unquestioned, and the oil will do no harm, 
especially if the daily bath frees the pores from any 
accumulation which might clog them. 

The band or woolen covering ought never to be 
Protecting left off. If it has been taken off, it should immediately 
abdomen ^ e P ut on > an d as tne ^ eet are inclined to be cold, it 
and feet [ s we \\ to use little socks or stockings, at least until the 
circulation is re-established and the disordered con- 
dition is corrected. Entire change of air and sur- 
roundings often does more for the baby than any 
amount of treatment or medicine, and if he can be 
taken away at once to where he will be able to breathe 
purer air, the trouble may be almost immediately re- 
lieved. The treatment of whatever sort should be 
given at once. The danger here lies, as it does in any 
disease which progresses rapidly, in delayed treat- 
ment. 

CONSTIPATION 

Constipation is too often the result of carelessness 
on the part of the person who has charge of the child. 
Care the From his birth, the condition of the bowels should be 
Xmid" given attention, and any disorder should be at once re- 
exerdse lieved. If the mother is nursing the baby, she can reg- 
ulate his bowels by attention to her own. She should 
take daily walks, drink plenty of water, and eat fruits 
and coarse bread, and, if necessary, use medicines to 
remedy the constipated condition, which will act upon 
the baby through the milk. 

Gentle rubbing of the baby's abdomen from the 
right groin up, across and down the left side, with a 
circular motion of the fingers, often stimulates the 
action of the intestines. This should be done two or 
three times each day, but not immediately after a meal. 



DISORDERS OF CHILDREN 359 

If a child is held over a small chamber, and the ab- Teaching 
domen is gently massaged, twice each day shortly after regularity 
he has had his bottle, he can be taught habits of reg- 
ularity at an early age. 

A little stimulation to the rectum may be all that 
is needed. A small cone of castile soap may be cut, 
and inserted for a moment into the rectum, or a very 
tiny bit may be pushed up and allowed to stay till it 
comes away with the defecation. Gluten suppositories 
may be used, but glycerine is usually too irritating. 
If the trouble lies in the sluggishness of action in the 
lower bowel, these remedies will be all that is neces- . 
sary. If the child is losing in weight, it may be that 
he is not getting enough food, and if he is nursing, 
one or two bottles of modified milk may be substituted 
for the breast feedings. A little cream or beef- juice 
given him before nursing may help him. 

With a bottle-fed baby, the amount of cream may 
be increased, oatmeal gruel may be added to the food, Modifka- 
and the lime water should be omitted. He should have b6ttie-° r * 
plenty of boiled water to drink, and if this treatment fed baby 
does not prove effective, olive oil may be safely given. 

Castor oil leaves a baby more constipated than be- Neither 

J r castor oil 

fore, so should not be used. Drugs should not be given nor drugs 
without a doctor's orders. remedy 

CONVULSIONS 

Convulsions may occur in connection with some 
disease, such as croup, diarrhoea, some of the infec- Causes of 

r . convulsions 

tious fevers, or as a serious brain trouble, but they 
are also caused by a disordered stomach, difficulties 
in teething, and extreme nervousness. 

The treatment in any case is the same, and meas- 
ures for immediate relief can generally be taken before 
it is possible to summon a physician. The head should 



860 



CARE OF CHILDREN 



Giving 
the warm 
bath 



be kept cool with compresses of cold water, or with 
bits of ice in an ice-bag or piece of oiled silk. The 
Treatment extremities should be heated, and for this purpose the 
doctor ' child should be given a mustard foot-bath — not hotter 
than 95 F. Two tablespoons of mustard to a gallon 
of water are used, and the feet and legs should be kept 
covered with the water till they are quite red. After 
the bath, he should be wrapped closely in a blanket, 
which will induce perspiration. 

If the child is small, and conveniences are at hand, 
the entire body can be immersed in the bath. If a bath- 
thermometer is not available, the bared elbow may be 
used to test the temperature of the water, using it no 
hotter than can be comfortably borne if no mustard 
is added, remembering that the mustard increases the 
stimulating action of the bath, .so that it is given at a 
lower temperature. 

If the convulsions continue, an enema should be 
given, for pressure in the bowels is very liable to 
cause them. If the bath has relieved the condition, 
a dose of castor oil will answer the purpose as well 
as the injection. 

TEETHING 

Teething can not be reckoned among diseases, 

Teething and is spoken of here very briefly, simply because it 

susceptible makes a child more susceptible to other ills, and 

ii°is° ther special care should be taken to keep all the conditions 

of his life as normal and hygienic as possible. 

He should spend as much time as he can in the 
open air, and the feet and legs should be protected 
with stockings and soft kid moccasins if short 
dresses are worn, and the care in the preparation of 
the food should be increased. The appetite may be 
variable, and the feedings should not be forced. 



DISORDERS OF CHILDREN 361 

The first teeth usually appear at about the sixth When the 
month. At about the fifth month there begins to be appear 
an increased flow of saliva, and the baby will need 
bibs, generally lined with some sort of waterproof 
cloth, to protect his dresses. 

Care must be taken that he does not form the 
habit of thumb-sucking' at this time. A little baby Restrain- 

. ' ing from 

can be restrained by drawing his dress sleeve down thumb- 
over his hand and sewing it over and over across su 
the end. A small bag tied over the hand has the 
same effect. 

If there is fever and restlessness, frequent sponge 
baths in alcohol and water will be found very quiet- 
ing. Sometimes the gums become so red and swollen 
that lancing is necessary and gives great relief. 

MILK CRUST 

This is most frequently seen on the head, and is 
often caused by lack of cleanliness over the fontanelles cause of 
or open spaces between the bones of the scalp. It crust 
is caused by the inaction of the tiny glands which 
manufacture oil, but it is allied to eczema, and should 
receive similar treatment. 

The hair should be cut as close as possible, and 
the crusts softened with oil or a simple ointment, like Treatment 
that made from boracic acid. It may be necessary 
to leave the ointment on overnight, after which the 
head is washed with warm water and castile soap. 

The scalp should be washed daily with warm olive 
oil, and fresh ointment, spread on a linen cloth, should 
be applied. 

The scalp is sometimes neglected on account of 
fear of injuring the delicate brain beneath the open- 
ing;. There is very little danger of this with the 
moderate energy required to keep it clean. 



362 CARE OF CHILDREN 

ERUPTIVE DISORDERS 

Eczema is another disease of the skin which at- 
tacks children more generally than adults. It may 
appear with the formation of crusts over the affected 
part, or the surface may seem reddened and moist 
In any case there is intense itching, and as scratch- 
Treatment ing may retard recovery very materially, the first 
of eczema requisite in its . treatment is' to protect the parts from 
the child's hands. The physician will advise the. 
ointment or powder which should be applied, and 
the use of water should be avoided for the process 
of cleansing, oil being used instead. Rest and quiet, 
with the thorough application of the remedy, gener- 
ally give good results 

On very little babies there sometimes appears a 

Cause is red rash like tiny pustules, which is found especially 

digestive on the face and neck, and about the buttocks. It is 

disorders g enera iiy due to a slight digestive disorder, and needs 

no treatment beyond powdering for comfort. 

Indigestion in children is often accompanied by 
a rash, and it may occasion alarm because of its 
resemblance to measles. Keeping the child warm and 
quiet, giving a warm bath and a laxative is always 
safe treatment, and a day or two will decide if the 
trouble is at all serious. 

HIVES 
Hives or nettlerash is another form of eruption, 
Treatment which is very uncomfortable though not at all dan- 
gerous. The itching is extreme, though one charac- 
teristic of the disease is that the blotches are not 
raised and apparent all the time. Bathing with 
water containing bicarbonate of soda (baking soda) 
soothes the irritation. 



DISORDERS OF CHILDREN 363 

PRICKLY HEAT 

Prickly heat is common in the summer, especially 
if a baby is kept too warm and has not frequent 
sponge baths. 

When the rash is troublesome the baths may be 
of tepid water, with a little vinegar or baking soda Remedy 
added. It may be wise to put on a short slip of h eat PnCk V 
cotton or linen next the skin, because the woolen 
shirt may be too irritating at this time. 

RINGWORM 

Ringworm is a disease caused by the action of a 
parasite, and is seen sometimes on the scalp and 
sometimes on other parts of the body. When it 
attacks the scalp it causes the hairs in the affected 
part to break off from lack of nutrition. 

It can be conveyed from one person to another, 
and for this reason painting with iodine or with Ringworm 

.,«.-.- i i . i * s conveyed 

collodion is often the treatment, as this serves the from one 
double purpose of protecting other children from Jnother° 
infection and of keeping the diseased area from dust 
and other irritation. 

Ointment of salicylic acid or carbolized vaseline 
is effective and any curative measures must include Treatment 
thorough soap and water cleansings. The name sug- 
gests the circular form of the appearance. 

CROUP 

Many of the diseases which used to be looked 
for as a matter of course during a child's life are 
much less common now that more reason is used in 
the feeding, clothing, and general care. 

The ordinary spasmodic croup may result from 
exposure or a sudden change from heat to cold, caused symptoms 
by wearing an unnecessary amount of clothing, or of croup 



364 CARE OF CHILDREN 

from an overloaded stomach. The attacks are gen- 
erally sudden. The child wakes in the night with 
hoarse breathing and the rasping cough which is so 
characteristic of the disease that once heard it is 
always recognized. 

Flannels wrung out of hot water and placed about 
Treatment the throat give relief, and the heat and moisture may 
be kept in by a piece of oiled silk. A mustard bath 
or a foot-bath is often given. Vomiting and a free 
evacuation from the bowels generally give great 
relief. The physician will probably give syrup or 
wine of ipecac, followed by drinks of warm water 
till vomiting results. 

The attack is often repeated for several succes- 
sive nights unless precautions are taken. These pre- 
cautions are light diet, quiet and rest, and free move- 
ment of the bowels. 

Membranous croup is altogether a more serious 

Membra- affair, and is classed by many physicians with diph- 

oup theria. The especial danger lies in the growth of the 

membrane in the throat. The character of the cough 

will indicate to the mother whether the throat is 

clear. 

In all cases of croup the air should be kept moist, 
Safeguards and this also gives great relief in bronchial colds. An 
of a croup es apparatus called a vaporizer can be bought at a drug 
store, but it is rather expensive, and the same effect 
can be obtained with a teakettle and a few feet of 
rubber tubing with a bore large enough to go over 
the spout of the kettle. 

Very often it is sufficient to keep the air about the 

Arrange- patient's bed in a moist state, but sometimes direct 

secure inhalations, medicated or not, are given, and in the 

Sanations case °^ cr °up the doctor may order a tent to be 

arranged over the crib so that the moisture may be 



DISORDERS OF CHILDREN 365 

confined. A screen or a clothes-horse may be placed 
about the head of the crib, and sheets may be hung 
over it in such a way as to keep in the steam very 
successfully. Special methods of inhalation have 
already been described. 

RICKETS 

If a child has improper food, or unhygienic sur- 
roundings, if he is fed exclusively on condensed milk How the 

i i • i-i i disease is 

or is kept too long at the breast, he is likely to induced 
develop a disease called rachitis, which, while not 
being of a serious nature in itself, impoverishes the 
system so that it is very susceptible to tuberculosis, 
and, in fact, to any disease. 

If the cause of the trouble is recognized and re- 
moved, and the child's food and exercise are regu- 
lated with regard to the highest ideals of health, 
entire cure of the disease is possible. 

The head of a child with rachitis is generally 
larger than normal, and it is inclined to perspire very symptoms 
freely so that the pillow may be quite wet. The disease 
blood is of poor quality, so that the child is very 
white and the flesh is soft "and flabby. All the tissues 
are lacking in tone, but it is the bones which show 
most plainly the results of the trouble. At birth the 
bone substance is largely cartilaginous, but the hard- 
ening or ossifying process is rapidly carried on till 
it is possible for a child to support the weight of the 
body on the legs, the bony plates of the skull no 
longer have openings between them, and the entire 
framework of the body is more rigid and unyielding. 

When a child has rickets this hardening of the How 
bones is not complete, and there is consequent danger results 11 * 7 
of deformity as an effort is made to sit up or to 
walk. The muscles of the back are insufficiently de- 



366 CARE OF CHILDREN 

veloped to keep the spine straight, so that a curva- 
ture is very noticeable; the weight of the body on the 
bones of the pelvis forces them out of place, and if 
an effort is made to walk the legs are almost surely 
bowed or knock-kneed. 

The pelvic deformity may cause no discomfort 
till later in life, but if the baby is a girl there may, 
be serious or even fatal consequences from it at the 
period of child-bearing. Other symptoms which in- 
dicate this disease are a protruding abdomen, en- 
larged joints^ constipation, and restlessness. 

The child needs an increase of fat in the food, 

Food for and may occasionally be given a strip of boiled bacon 

w ith to suck. The bacon should be thoroughly cooked, 

nckets k ut not cr - S p enough so that he can break off bits in 

his mouth. 

The food should be varied, and of course his age 
will decide how much deviation is possible, but the 
existence of the trouble indicates that more nourish- 
ment is required. Beef -juice, broths, and fruit- juices 
are advisable, but starchy and sweet food should be 
limited. Daily baths and thorough rubbing must be 
given, and plenty of fresh air and sunshine are always 
prescribed. 



CHOREA, OR ST. VITUS'S DANCE 

How "Chorea is a disease characterized by irregular 

fancfc'is 18 S spasmodic contractions of different muscles or sets 
brought on f milS cles, especially of the upper and lower ex- 
tremities." It attacks children chiefly, usually at 
about the period when the second teeth are coming 
through, It is a nervous disorder, v and may be 
brought on by fright or by the excitement of com- 
petition in school. It often seems to accompany rheu- 



DISORDERS OF CHILDREN 367 

matic and heart disorders, though many times the 
attack seems quite independent of other diseases. 

The twitching of the muscles may be slight, but 
in severe cases it becomes so constant and violent Symptoms 
that the child can not walk or speak, take nourish- 
ment, or even lie quietly in bed. During sleep there 
is usually rest. 

A child showing any signs of chorea should be 
taken at once from school. Absolute rest in bed is Treatment, 
the most effective treatment for the first week till im- and Vest 
provement begins. After that the exercise should 
be moderate, there should be no mental excitement, 
and the diet should be nourishing and easily digest- 
ible. Milk and eggs should be given in plenty, and 
koumiss is advised if the child has a liking for it. 

Above all the night should be restful, and a phy- 
sician will probably prescribe a sedative if there is a How 
tendency to sleeplessness. The society of other children 
children is not advisable, because if they are inclined ma y . . 

. . . . . acquire the 

to be nervous at all they have an inclination to imi- disease 
tate the awkward motions of the patient, and may 
even contract the disease. On the other hand she is 
less able to control her movements when she is em- 
barrassed by observation. 

There should be no thought of putting her back 
into school until recovery is complete, and all mental The 
strain should be avoided for a year or more, in order need" 1 
to guard against the possibility of a second attack. lon s rest 
It should be remembered that a healthy body is the 
first requirement in the child's equipment for life, 
and the early years of school count very little when 
weighed against a loss of physical or nervous vigor. 



VI 

CONTAGIOUS DISEASES 

Mumps— Whooping - Cough— Measles— Chicken - Pox— Scarlet Fever— Neces- 
sary Precautions in Contagious Diseases— Scarlet Fever is 
Infectious— Diphtheria 

IT should not be taken for granted that a child 
must go through the entire list of contagious 
diseases. The susceptibility to most of the diseases 
decreases with the years, and as a general rule we 
may say that the mortality is less among older chil- 
dren than among babies. 

The diseases of children are regarded too much 
a child m a fatalistic way, as if they were a foreordained 
though' g ° m > with little attem P t at mitigation. On the other 
the con- hand, there is no need of borrowing trouble and of 

tagious .. . ii- 1 

diseases avoiding contagion by unreasonable caution and over- 
suppose carefulness. The mother who takes her children 
to°cMd- out °^ a neighborhood when a case of measles is re- 
hood ported there, is quite as likely to find it in the house 
with her at the end of her journey. 

MUMPS 

This is a disease affecting the salivary glands, es- 
pecially the one lying back of the ear. 

There is difficulty in swallowing and acute pain, 
Symptoms especially when taking food. The trouble begins 
with chill, headache, and a general . feeling of dis- 
comfort. 

The period of incubation, that is, the time be- 
tween exposure and the first symptoms of disease, is 
(368) 



CONTAGIOUS DISEASES 369 

from eight days to two weeks, and the pain and 
swelling begin to subside after four or five days. 

Cloths wrung out of hot water help to relieve the Relieving 
pain somewhat, and there is little treatment besides f mumps 
this. As is usual in any disease, the bowels must be 
kept open, the diet should be light, and the child 
should be kept quiet in a well-ventilated room of 
even temperature. This disease is both infectious and 



WHOOPING-COUGH < 

Whooping-cough is an infectious disease, and be- 
gins very much like a catarrhal cold. The charac- 
teristic "whoop" may not be heard for ten days. 

The attacks of coughing are spasmodic, and the 
feeling of strangulation is very distressing. The fits 
of coughing often end in vomiting, though otherwise 
the stomach seems unaffected. 

The child should be instructed to close his eyes Special 
while he is coughing, because of the strain which to the 
sometimes causes them to become crossed. sufferer 

He should be kept out of doors as much as pos- 
sible, if it is warm weather, and if the fever which 
often is present in the beginning has subsided. If Fresh air 
the autumn comes on before the cough has stopped, tre atment 
it may run on and prove troublesome during the cold 
weather. For this reason a change of air during the 
later stages may be advisable, since it often shortens 
the attack. 

MEASLES 

Measles is an extremely contagious disease, and 
spreads so rapidly that it is liable to become epi- 
demic. The period of incubation is from eight to ten 
days. 

The first symptoms are those of an ordinary cold 



370 



CARE OF CHILDREN 



Symptoms 
of measles 



The rash 
of the 
measles- 



Length 
of the 
patient's 
seclusion 



Special 
care of 
the eyes 
and mouth 



The 
warm bath 



in the head. There is marked influenza, the discharge 
from eyes and nose is watery and profuse, and is 
accompanied by a cough. This is the period when 
there is most danger of contagion. There is gener- 
ally some rise of temperature and headache. 

A physician can detect the rash in the throat and 
the roof of the mouth before it appears on the skin, 
where it generally can be seen on the fourth day, 
first on the forehead, then upon the neck and chest, 
rapidly spreading all over the body. It is a dull red- 
dish color, and feels distinctly rough under the fingers. 
The tiny spots soon run together, leaving crescent- 
shaped patches of clear skin between. 

The rash remains in evidence for two or three 
days usually, and with its disappearance the other 
symptoms gradually subside. Desquamation, or peel- 
ing of the skin in fine scales like bran, follows, and 
the child should be kept away from other children 
for two weeks after this has entirely ceased. 

As a rule measles is not a difficult disease to care 
for. The child should remain in bed, carefully pro- 
tected from draughts, but not too warm; the room 
should be well ventilated and kept at a temperature 
between 68° and jo° F. The diet should be light, 
and the bowels should be kept open. 

The eyes are generally inflamed, and they are ex- 
tremely sensitive to light. 

The room should be darkened, and the eyes should 
be bathed two or three times a day with a boric solu- 
tion. Lack of care in this detail sometimes leads to 
a permanent weakness. The mouth also needs fre- 
quent rinsing. 

During the peeling a warm bath, under a blanket, 
should be given each morning, after which the whole 
body should be rubbed with vaseline. This prevents 



CONTAGIOUS DISEASES 371 

the scales of skin from flying about, and also allays 
the itching. 

The complications in measles are what make it 
a disease to be feared. With babies and very small tions in 
children there is a liability to pneumonia which makes 
watchful care necessary, and which calls for a physi- 
cian's supervision over the condition of the lungs. 

The child should be completely isolated, and if 
possible the person caring for him should have noth- 
ing to do with the rest of the family. This is not ^ h e e ssening 
practicable in homes where the mother must be nurse dan ? er . of 

r contagion! 

and housekeeper as well, but she can lessen the 
danger of contagion by proper care. 

Cotton dresses should be worn whenever one is 
caring for the sick, and if the mother keeps a large 
cap and a garment like a long-sleeved, high-necked 
pinafore just outside the chamber, and always wears 
it when waiting on the child, the risk of unneces- 
sarily communicating the disease is reduced. She 
should be careful to wash her hands before touching 
anything outside the sick-room and should never use 
for the child a towel or handkerchief which is to 
serve any other purpose. 

The discharges from the nose and eyes are the 
most direct means of communicating the disease, and 
since the complications may be so serious we should 
be very conscientious in our efforts to keep other 
children from exposure. 

The clothing and bed-linen used about the child 
should be soaked in a solution of carbolic, one ounce i ng the 
of the acid to two gallons of water. They should j^^Tes 
then be boiled for half an hour before they are 
handled by the laundress. 

Before the child leaves the room he should be 
given a full bath in a 1-5000 bichloride solution. 



372 



CARE OF CHILDREN 



Disinfect- 
ing the 
room 



Contagion 
of chicken- 
pox 



The rash 
or pox 



Relieving 
the 



The 

patient's 
isolation 



Then he may be wrapped in a clean blanket and 
taken into another room, where fresh clothing may 
be put on. 

The room must be fumigated before it is used, 
and in most towns this is put into the hands of the 
Board of Health. In the country, where there is 
no such provision, it will be done under the doctor's 
supervision. 

CHICKEN-POX 

Chicken-pox is a mild contagious disease, which 
attacks children of all ages. It may be communi- 
cated by a third person or by direct contact, and may 
appear at any time between ten days and three weeks 
after exposure. The liability of contracting, it is 
much less as time goes by. It is an intensely uncom- 
fortable disease, on account of the itching, and be- 
cause scratching must be prohibited. 

A slight fever may introduce it, but the rash is 
often the first indication. This appears first as reddish 
pimples, which come out in successive crops all over 
the body, being thickest on the back. The spots soon 
become blisters, which dry, leaving crusts. These 
may drop off in the course of five days, and they may 
remain for over two weeks. 

If the eruption has been deep or if the crust has 
been removed before it is loosened there may be 
slight scarring, but this is not usual. If the body is 
rubbed with vaseline the irritation will be relieved, and 
the scratching must be prevented because of the 
danger of poisoning if the finger-nails come in con- 
tact with the open sore. 

A child should be kept in bed as long as the fever 
lasts, and in fact while the eruption is appearing he 
will probably be most comfortable undressed. He 



CONTAGIOUS DISEASES 373 

should not be allowed to play with other children 
till the skin is quite clear. 

Fumigation, while not so essential as in more 
serious diseases, is an advisable course when there 
is any chance of exposure to other children. 

SCARLET FEVER 

Scarlet fever is one of the most serious of the 
contagious diseases, more by reason of its complica- 
tions and the illnesses that sometimes follow it than 
by its direct results. Children under one year old are 
less susceptible to it, and it is supposed that grown 
persons rarely contract it. 

One attack generally renders a person immune. 
It is communicated by direct exposure, by contact scarlet 
with a third person, with articles that have been used i s commu- 
about the sick-room, by being in a room which has mcated 
not been fumigated. 

The first symptoms generally make their appear- 
ance about a week after exposure, though the time 
may vary from three to twelve days. Increase in symptom! 
temperature is very rapid, making us suspect that it ? f scarlet 
is more than an ordinary cold, even if the acute sore 
throat did not alarm us. Nausea and vomiting are 
generally early symptoms, and with little children 
there may be convulsions. White spots appear on 
the tonsils, and the appearance of the tongue is very 
characteristic — a white coating dotted with bright red 
spots, giving it the name of ''strawberry tongue." 

The rash, which generally comes out on the sec- 
ond day, is bright red, finer than measles and so 
close together that the whole body looks scarlet. It The rash 
is seen first on the neck and chest, and rapidly ex- 
tends over the whole body. Ordinarily the rash re- 
mains out for about five days, but the desquamation 



374 



CARE OF CHILDREN 



Special 
care in 
the desqua- 
mation 



Baths and 
ventilation 



Watchful- 
ness 
against 
colds and 
resulting 
kidney 
disorder 



Earache 
with 
scarlet 
fever 



often takes two and sometimes three weeks. The 
skin is shed in much larger scales than in measles, 
and this period of the disease is considered the most 
contagious. Care must be taken to keep these scales 
from being scattered about the room, and the rub- 
bing with oil Or vaseline is of use on this account. 

Washing the mouth, spraying the throat, and 
giving frequent sponge-baths if the temperature is j 
high help to make a child less restless, and relieve 
the suffering. If the fever is high, ice-bags or cool 
compresses on the head often quiet the restlessness. 

Particular care should be given to ventilation, and 
to keeping the room at an even temperature, and the 
food should be liquid, and diluted if the child is still 
on the bottle. 

The skin with its glands assists in the work the 
kidneys carry on, of ridding the system of waste 
matter. During desquamation there is especial danger 
of catching cold, which interferes with this function. 
It then happens that an extra burden is laid on the 
kidneys, and they are very liable to become diseased. 
This is one of the complications to be guarded against 
in scarlet fever, and it is well for the mother to save 
specimens of the child's urine for the doctor's exam- 
ination. 

This trouble may appear after the child is ap- 
parently well, so the watchfulness must not be re- 
laxed, and the doctor must be consulted if the urine 
at any time seems unnatural in color or quantity. If 
the limbs or eyelids seem unduly swollen or puffy it 
should be at once reported. 

Earache sometimes still further complicates the 
disease, as it may leave a child permanently deaf 
unless it is attended to at once. It is due to the fact 
that the inflammation of the throat has extended up 



CONTAGIOUS DISEASES 375 

into the ear, and the physician will puncture the ear- 
drum, which gives relief and often saves the hearing. 
When the inflammation subsides the small hole in 
the drum will soon heal over. 

PRECAUTIONS IN CONTAGIOUS DISEASES 

All the precautions necessary in other contagious 
diseases are to be observed here, and with doubled 
care, since the fever itself and its complications are 
more serious, and the dangers of spreading the con- 
tagion are increased. 

The attendant should never go from the sick child Care . 
into rooms where there are children, in the same the at- ( 
clothes* that she has worn when caring for him. The dress 
cap and long gown should always protect her hair 
and dress. 

The dishes and utensils used for him should be The sick 
kept by themselves, and boiled before they are again meTsiis 
used by the family. Above all, the scales of skin should 
not be scattered about. Rugs or bed-clothing should 
never be shaken out of the window, and everything The rugs 
used about the child should be soaked in carbolic and clothes 
boiled before being washed. A doctor or nurse going 
about from house to house finds strange inconsisten- 
cies in the care of contagion. 

They do not wonder at the spread of disease when 
they find a seltzer-water bottle at the bedside of a child instances 
who is in the worst stage of desquamation. He uses it ° n f g sp d r j e S ease 
himself whenever he wishes, and it is returned to the through 

...... . careless- 

shop, bearing with it a chance for direct infection, ness and 

The milk bottle is used in the same way, and then taken thought 

down to be washed with the household dishes. 

The mother goes into the sick-room/- takes a corner 

of her apron to wipe her child's forehead, and with no 

change, and without a thought of danger, returns to 



376 CARE OF CHILDREN 

her other charges, who cling to her skirts, and are al- 
most sure to come down with the disease at the end of 
the usual period. It is almost impossible in a home 
where the rooms are not large, and where the helpers 
must be few, to completely isolate patient and nurse, 
and to observe with absolute consistency all the ideal 
precautions, but much of the carelessness we remark is 
quite needless, and is born of lack of thought, rather 
than of ignorance. 

While speaking of the dangers of contagion it will 
be well to emphasize also the fact that scarlet fever is 
extremely infectious as well. 

SCARLET FEVER IS INFECTIOUS 

A nurse who has been caring for a scarlet fever pa- 
tient should absolutely refuse to go from him to a sur- 
gical or maternity case. The chances of infection are 
many where there is an open wound, and in child- 
birth both mother and child are especially susceptible, 
and there have been many cases of blood-poisoning re- 
sulting from lack of knowledge on this subject. The 
danger is even greater, of course, when the patients are 
in the same house, and in that case the isolation should 
be more rigorously enforced, and on no account should 
the nurses or attendants go from one sick-room to the 
Safeguard other. A sheet hung across the doorway of. the pa- 
su S a pended tient's room, and kept wet with a deodorant or with 
wet sheet pi am wa ter, is an additional safeguard. 

At the end of the convalescence, the nurse and pa- 

Care tient must take baths in bichloride of mercury, fol- 

leaving lowed by warm soap and water. Even the hair should 

room ick " De carefully washed, and afterward the clean clothing 

must be put on outside the sick-room. 

The utmost precautions regarding fumigation 
should be observed. Anything which can not be ren- 



CONTAGIOUS DISEASES 377 

dered absolutely germ free must be destroyed. It is 

wise to provide the child with inexpensive toys and Precautions 

r . regarding 

books which may be burned when he leaves the sick- fumigation 
room. Most chambers are not very well planned for 
contagious disease. We hardly realize how many 
catch-alls for germs there are until we carry a patient 
through some such illness, and the question of disin- 
fection comes. 

A thorough fumigation with formaline vapor is 
probably effective enough to make the ordinary fur- Effective 
nishings safe for use, but unless one is assured of the furr »g atlori 
results, the risk seems hardly worth taking. If the 
walls are papered, it is much wiser to have them 
scraped and repapered or painted. Woodwork and 
paint should be washed with a disinfectant, as well as 
being subjected to the general fumigation. 

When a house is large enough, it is a very good 
plan to set aside one room as a "hospital ward." It An ideal 
should be sunny and airy, with facilities for easy venti- "hospital 
lation, and no furniture which can not be easily cleaned, in the 
Hardwood floors, painted walls, an iron bedstead, and ome 
no draperies are some of the essentials, all of which 
have been more fully discussed in a previous chapter. 
A bathroom or running water and a closet should be 
close by, and if there could be a separate staircase, so 
that the room could be completely isolated, the condi- 
tions would be still more ideal. 

DIPHTHERIA 
Diphtheria is also an infectious and contagious dis- 
ease, often resulting from imperfect sewage. Care- Search 
ful examination of drains and pipes should be made the 

x * m cause of 

wherever there is a case of diphtheria, in order that diphtheria 
the spreading of the disease may. be prevented. 

It attacks children of all ages, and adults as well, 



378 CARE OF CHILDREN 

and one is not immune after one attack. It results 
from a micro-organism, which causes the growth of a 
false membrane over the lining of the throat. 

The tonsils are first attacked, and it is there that 
Symptoms we first notice the exudation, which is of a character- 
theria istic gray color. In children, there may be more delay 
in recognizing the disease, because they do not make us 
understand their symptoms. Any sore throat with 
spots on the tonsils should be regarded as suspicious, 
until it can be proved to be a simple disorder. 

The onset is very like acute tonsilitis, with head- 

The onset ^j^ c hJUy sensations, and pain and soreness in the 

bones and muscles. The glands in the neck are usually 

somewhat enlarged and in very young children this 

may be the earliest noticeable sign. The temperature 

is not always high, though it may run to 105 °. The 

attack may begin twenty-four hours after exposure, 

or it may be three weeks before there is any sign of it. 

Examina- A suspected case of diphtheria should be immedi- 

tion of ately isolated, and a doctor will remove some of the 

exudation J ' 

exudation in the throat, and will subject it to micro- 
scopical examination, in order to pronounce definitely 
upon the nature of the trouble. 

In the meantime, the patient must be kept very 
quiet, great care must be taken to keep up his strength 
Treatment with nourishment, which should always be liquid, and 
generally some sort of stimulant will be ordered for 
the same purpose, as the prostration is extreme. The 
treatment of diphtheria consists of strict regard to 
hygienic conditions, in the administration of remedies 
to counteract the effect of the poisonous germs which 
produce the disease, and by operation, either intuba- 
tion or tracheotomy. 

The second form of treatment consists generally of 
the injection of what is called antitoxin serum. This 



CONTAGIOUS DISEASES 379 

treatment is the result of investigations in bacteriolog- 

i • • 1 'Antitoxin 

ical laboratories, in order to find a fluid, which taken serum 
into the blood of a patient suffering with diphtheria 
would arrest the growth of the bacteria which cause 
the disease. This fluid is serum from an animal which 
has been rendered immune to the disease by inocula- 
tion with the poison which brings it about. 

When physicians began to use antitoxin, so many 
disorders seemed to arise in consequence that it came 
to be regarded very unfavorably by many persons. 
Its value as a remedial agent in all instances is per- 
haps not unquestionably established, since its opponents 
can still point to some cases where its administration 
has been attended with serious consequences. The 
conditions under which it is prepared have improved, serum in 
and the results are in general so good that with most dl P hthena 
physicians its use is a routine measure in cases of 
diphtheria. This treatment is, however, left entirely 
to the doctor's judgment, the attendant's part being to 
follow orders with explicit exactness. 

The throat and nose will require careful swabbing, 
and as the discharge is extremely poisonous, the nurse Bum the 
must be careful not to receive any of it on her face or ^dnose 
clothing. The cotton used for the throat as well as the swabs 
cloths which receive the expectoration must be burned. 
Bed, linen, dishes, and room must be most carefully 
disinfected before being used again. 

With children, the disease progresses so rapidly 
that sometimes the breathing and swallowing are al- 
most entirely obstructed by the swelling of the air- 
passages before the real nature of the trouble is 
recognized. In such a case a metal tube is sometimes 
inserted, either through an incision made from the intuba- 
outside into the breathing passage, which is called {richest- 
tracheotomy, or through the mouth, a process known omy 



Atmos- 



380 CARE OF CHILDREN 

as intubation. An atmosphere of steam greatly re- 
lieves the difficult breathing, as it does in bronchitis 
or in croup. 

The tent and vaporizer described in the foregoing 
phere of pages on croup may be used here with good results. 
If any drug is used in this connection, it should be 
one prescribed by a physician. 

As with scarlet fever, the complications are to be 

most carefully guarded against. The heart becomes 

The weak very weak, and any violent exertion, such as sitting 

heart with 111 • r 

diphtheria up suddenly or reaching for something, is an actual 
danger. Even very mild cases may be followed by a 
slight temporary paralysis, more often manifested in 
the throat, when it interferes with speech in small 
measure and with swallowing to a considerable degree. 
The general condition after diphtheria is one of great 
exhaustion, and associated as it is with weakness of the 
heart, it needs time and rest and nourishing food in 
order that health may be firmly re-established. 

While scarlet fever and diphtheria are most serious 
and heart diseases and are sometimes attended by alarming con- 
nurSng" sequences, it is a comfort to remember that they may 
these dis- ta k e a m ild form, when recovery is speedy and un- 

eases 1 

eventful. This does not mean that care and watchful- 
ness can be relaxed in any case, but it will perhaps re- 
move some of the unreasoning horror, which really 
incapacitates a mother from making her best effort. 



VII 



PROBLEMS OF PUBERTY 

Development of the Child— Puberty— Instruction to the Child— Masturba- 
tion— Menstruation— Bathing during Menstruation 

DEVELOPMENT OF THE CHILD 

THE physical and mental development of children 
proceeds along certain well-defined lines — as 
their relations to their environment become more com- 
plex, their needs are correspondingly multiplied. 

The first requirements are the nourishment of the 
body and the growth of its tissues to fit it for its place festive 6 
in life, hence the early development of function is tract 
largely confined to the digestive tract — the increase in 
the size of the stomach, the appearance of teeth, and 
the gradually acquired ability to take and digest a 
varied diet. 

Locomotion opens the world to the child, putting it Locomo- 
into communication with things and persons outside it- 
self. The relation, however, lacks the personal element. 
It is Nature, not personality, that impresses him ; in 
fact, he is living outside the world of social relations. 

The power of observation comes to him before he The power 
understands what he sees, and the last faculties to de- £ f OD observa ' 
velop are those that concern his life with his fellows. 

Interest in them, friendliness and affection are 
aroused first, and Nature reserves her gift of sexual 
power till she has fortified her children to withstand its 
dangers, and has given them power and knowledge to 
use it wisely. This is what puberty ought to mean — a 

(381) 



382 CARE OF CHILDREN 

What P u- coming into the full inheritance of vigor, strength and 
means power, and that is what it can mean, if we ever open 

our eyes and see where Nature and the evolution of 

her laws are leading us. 

PUBERTY 

The age oi The "age of puberty" extends over the years be- 
puberty tween thirteen or fourteen and sixteen, various circum- 
stances modifying the time of development, climate, 
race, occupation, and method of living causing great 
differences. The changes that are taking place are those 
concerned in the growth and development of the gen- 
erative organs, but this rapid growth entails very sig- 
nificant changes in the mental and nervous nature, 
which make the need of oversight and careful guid- 
ance especially important. In either sex, the changes 
are preparatory to the establishment of the function of 
reproduction. 

In both man and woman there is the growth of 
Physical na i r about the pubis and in the armpits. With males 
the"boy "* ^ s growth is found also on the face and chin, and 
often exists more generally over the surface of his 
body than on that of the female. The shoulders broad- 
en, the vocal cords lengthen and the voice grows 
deeper. The changes in the generative organs are the 
increase in size, the strengthening of muscular power, 
and the secretion of the fluid containing the repro- 
ductive germ. 

The physical changes in woman are somewhat 

changes 1 in more general, because her form must be adapted for 

the girl the work of child-bearing. There is a general filling 

out of the frame and a broadening of the hips as 

the pelvis increases in size. The breasts rapidly begin 

to develop, and the quality of the voice is altered. 

The internal changes, however, are more marked. 



PROBLEMS OF PUBERTY 383 

Immature ova are present in the ovaries from birth, 
but at this time there is established the periodic dis- 
charge of one or more of these ova, which, with the 
bloody fluid that accompanies it, constitutes men- 
struation. 

If these functional changes were all, there would 
be reason enough for increased care regarding the Mental and 

. . -. . . . fe . , , spiritual 

hygienic conditions, m the lives of young girls and changes 
boys at this period, but the differences that become 
manifest in their tastes, in their characteristics and in 
their attitude toward their fellows in the family and out 
of it, denote a modification in the nervous system 
which works the miracle of transforming the boy to a 
man and the girl to a woman. 

This rapid evolution is not without its painful side. 
The grace and unconsciousness of childhood are gone ; 
a keener sensitiveness, a fear of criticism, and often 
an occasional deep depression of spirits make them- 
selves felt. There is besides a deepening joy in exist- 
ence. A feeling of responsibility has awakened, which 
may have interfered with the child's spontaneity, but 
high ideals, ambition, and the desire for the best 
things of life are stirring within the heart, and the 
time is ripe for fixing the nobler aspirations. These 
feelings are not well defined ideas in the child's mind, 
which is chiefly a seething chaotic mass awaiting 
creation. 

INSTRUCTIONS TO THE CHILD 

As the child approaches the age of puberty, spec- 
ulations inevitably arise in his mind about the prob- problem of 

J r the repro- 

lems of life, which have to do with his own develop- auction of 
ment and with the reproduction of the race. This is 
the time when he should have careful, conscientious 
instruction from his parents or other close friends, 



384 CARE OF CHILDREN 

before unscrupulous enlightenment of most repulsive 
detail has been given him by vulgar and perhaps 
debased comrades. 

There is no reason why this knowledge should 
The simple come with a shock to a child, if due preparation for it 
tkSisTrom has been made by the parents. Life is always an inter- 
low"? and est i n g subject to him, and it may be studied and its 
animals different processes explained with absolute simplicity 
in plants and in the lower animals. He will make no 
application to human functions until the questionings 
begin to stir and then he will draw his conclusions 
quite naturally, and there will be a much less violent 
adjustment of his point of view. 

A child who knows Miss Morley's "Song of Life," 
,. or who has been shown how some plants bear both 

The old- r 

fashioned pistillate and staminate flowers, and the methods of 
deceptions fertilization when these flowers are borne by different 
plants, can not long be deceived by the tiresome plati- 
tude about the new baby's journey in the doctor's bag. 
Deception is not necessary. It often does not deceive, 
but almost invariably destroys confidence. It is often 
legitimate to refuse to answer a child's questions, but 
one gains more by telling him that he must wait till 
he is older than by a falsehood that may seem plausi- 
ble, but which he will inevitably recognize later as a 
deliberate untruth. 

Nature's work is the mother's best assistant, and 
work'the the view that one gets of life processes in that way 
™ e ° s t t her ' s has a beauty and a dignity which one can ill spare, 
assistant but which in our halting human account of them we 
do not always convey. Reverent, dignified, straight- 
forward expression is what a child should receive. 
There should be no veiled language, but the portion 
of the fact which is to be given should be told with 
simple exactitude. 



PROBLEMS OF PUBERTY 885 

Above all he should be made to feel that the ques Donotdis- 
tioning is expected and that the feelings that prompt confidence 
it are understood, and that the parents are his natural child 16 
confidants, with whom he can talk over his perplexi- 
ties. 

When the mother observes the first changes which 
accompany puberty, she should explain to the boy or ^ h 
girl the meaning of them. In the case of the boy plaining 

i • i r ±i • At a ji • the mean- 

there is not the same necessity for this that there is mg of the 

with a girl, though we must not lose sight of the fact changes 

that the same sort of forces are seething within his 

nature and the time is perhaps more critical with 

him than with his sister. The external signs may 

distress her exceedingly, and if the menstrual flow 

comes on before she understands about it there may 

be serious consequences resulting from her ignorance. 

She may resort to hot water or sea baths or some 

such violent measure, which will very probably check 

the flowing, and the nervous shock may have serious 

consequences. 

Not to explain the changes is, besides, unfair 
treatment — which we should above all things avoid 
in our dealings with children. 

We have spoken of the gradual evolution of the 
faculties of a child in the order of their complexity. 
In the beginning of each, instinct rules its use until 
reason enters in. , 

The full development of the sexual power brings The in- 
with it a riotous flood of sensations. The child who ^capacV 
has always been swayed bv his sensations, who has ty for sen 

. . sation 

gained his knowledge and had his pleasure through 
the sense-perceptions, finds that with the door to 
adult life thrown open to him the capacity for sensu- 
ous enjoyment has deepened. 

This realization of the character of the sexual 
l 7 Vol. 3 



386 



CARE OF CHILDREN 



Teaching 
self- 
control 



When the 
develop- 
ment has 
been un- 
even 



The old 
fable of 
woman's 
creation 



Mother- 
hood not 
woman's 
sole end 



life may be delayed long past the age of puberty, and 
certainly will not be felt till the development of the 
sexual function is complete, but certain teachings can 
forewarn him of the need of self-control and of the 
danger of following the guidance of instinct. The 
surest safeguard, the best preparation that can be 
given a child for the conflict between these surging 
forces that rise to do battle within him is that health 
of mind and body which comes from well-balanced 
development. 

When the physical and emotional sides have been 
hedged in and their expression restricted or limited 
tp the playtime, when it is as a rule quite undirected, 
there are fewer pleasurable activities to absorb the 
attention, and considerations of the new sensations 
are held in exaggerated importance. On the other 
hand the mind is incapable of forming judgments or 
of exerting will power if the physical education has 
been at the expense of or unaccompanied by the intel- 
lectual. A girl needs this balance no less than a boy. 

It is quite time that we, cast aside the notion that 
the sole purpose of a woman's creation was to serve 
man's pleasure and bear him children. Nature does 
not waste forces in that way. Her lower forms that 
are born, bring forth their young and die, evidently 
serve an admirable end; but she has used no elabora- 
tion of design in their construction. 

She has filled a woman's life with possibilities, and 
has emphasized the fact that motherhood is not the 
sole end, by extending her life and vigor far beyond 
the child-bearing period. Even when we believe in 
the laws of gradual evolution we fail to realize that 
they are even now in progress and that mankind is 
reaching out toward a higher degree of development 
physically, morally, and intellectually. 



PROBLEMS OF PUBERTY 887 

Women stand with men in much of the work of in the 
life. They ought at least to be given equal chances Hf e r £o- 
in their early education, before they can choose for "^ ^JJ d 
themselves what they will attempt to accomplish in 
the later years. 

The sex distinctions in childhood are largely a 
matter of training. The difference is emphasized by T .he sex 
adults long before the children themselves are at all in chiid- 
conscious of it. The dress accentuates it, but most baneful 
of all the repression of physical activities marks the 
dividing line. 

Where can the advantage of this method lie? We 

hear it said that a girl loses her femininity when she 

romps and plays with her brothers, and shares their 

active sports. Is it femininity that we want in a ... 

r J Woman- 

woman ? Womanliness is the sweeter quality, and Hness 

gains through vigor of- body and mind, as manliness 

is linked with courage and strength. 

The children then of both sexes should be asso- 
ciated in their work and play with no attempt at 
emphasizing sex. They are very primitive little ani- 
mals, and many of the accepted tenets of civilization 
seem to them like arbitrary dogmas. Their rules of conduct 
conduct may be fashioned on very simple lines, being children 
based largely on the elemental principles of fair play 
and consideration for other persons who form with 
them their social world. 

As they gain physical control in their sports and 
hand work, they will be progressing step by step in 
mental balance, which will be shown when real de- 
cisions are to be met. 

In childhood the physical rules ; in youth the mind 
should hold sway over the emotions. Real self-control JJjL*?, 
is attained through activity rather than through re- y° uth 
presston, and the strictly intellectual life represents 



388 CARE OF CHILDREN 

the fullest and the richest attainment no more truly 
than does the strictly physical. 

MASTURBATION 

Educators perhaps even more than parents real- 
ize the child's peculiar need of oversight not only 
during puberty, but throughout the earlier years. 
The habit Their reports show an appalling prevalence of the 
abuse habit of self-abuse, or masturbation, a habit which 
may be self-taught, but which is often communicated 
from older to younger, which possesses an over- 
mastering power, and which if not overcome is fol- 
lowed by unmistakable evidences of general deterio- 
ration. 

The care of the external organs should be taught 

a child, just as dressing himself or bathing is taught 

the^each- him. Careful cleansing should be insisted upon, for 

ing of care the irritation arising from neglect is often the cause 

and clean- ° ° 

Hness of masturbation, but he can be made to understand 
without a question that the parts are of delicate con- 
struction, as the eye and ear are, and that there is 
danger of injury by unnecessary handling. 

Eczema or a like eruption may appear in the 
groins or about the vulva^ when the irritation is un- 
difficuities bearable and the concentration of mind on those parts 
to hl s df- ead an d the nervousness which the intense itching occa- 
abuse sions are conditions which should receive prompt at- 
tention. Intestinal worms are also said to have been 
the reason for a child's contracting the habit. 

With boys the most frequent cause is a slight de- 
fect in the construction of the penis. This condition 
is known as phimosis, and is indicated by the tight- 
ness of the foreskin, which can be rolled back with 
difficulty. The opening is likewise so small that 
the urine is voided with great pain and after pro- 



PROBLEMS OF PUBERTY 389 

longed effort, and during the process the foreskin is 
sometimes filled up, causing intense pain. 

Circumcision is the treatment for such a condi- The 
tion, and as it is a very simple operation, attendant remedy of 

circum- 

with no serious consequences if properly performed, dsion 
it is always to be advised. 

Parents should make very sure that there are no 
functional disorders which the child is concealing, 
either from ignorance or from a feeling of shame. 
If the parents are also the child's comrades and th^form- 
f riends, confidence will be natural and one great source j^jj he 
of danger will be shut out. Children should not 
sleep together if it can be avoided, and the habit of 
lying in bed after they are awake should be dis- 
couraged. 

A mother must be very careful in regulating the 
dress of her children, to see that the underclothes 
and the trousers do not constrict the body in any Car eofthe 

, , . , . clothing 

part, and that there is no unnecessary rubbing or 
pressure. The same care should be taken with the 
night-clothes, and the closed night-drawers, which 
are the best for both girls and boys, should be made 
large and full. 

The position which children take in bed is also 
important. The rrtother or nurse should look out for i„ bed 
that as well, and teach, them to lie on one side with 
the legs flexed. 

Care should always be taken in the choice of 
companions for a child. As a rule it is better that trades* 
he associate with those of about his own age and of 
both sexes. Knowledge of an undesirable sort is so 
often brought to children by older comrades that 
unless the character of the older girls and boys is 
known it is better to avoid close intimacy with 
them. 



390 CARE OF CHILDREN 

The choice of a school is a very important one. 
Teachers can tell what a tendency there is to this 

Choke of particular evil and how quickly it makes itself ap- 
parent in a school. There ought to be a stronger 
spirit of co-operation between school and home, and 
also a keener sertse of responsibility on the part of 
teachers. Parents too often resent the interference 
of teachers, and refuse to recognize wrongdoing 
in their children, even when it is pointed out to 
them. 

If it is possible to choose a school where at least 
half of the working day is given up to hand-work 

Outlet for and physical exercise, a long step toward ensuring 

energy *he safety of the children will be taken. Occupation 
of the mind is an essential, and that is much more 
likely to be found with occupation of the hands than 
when the tasks involve mental processes only. There 
seems to be a certain amount of animal energy bottled 
up within most children, and the more natural out- 
lets are given the less likely he is to find unnatural 
and harmful ones. 

A watch should be kept over the books that are 
put before young persons, but it should be apparent 
as interest rather than as espionage. 

If the best books are placed fn their hands from 

of h b C o h k°s ice ^ e ^ rst > taste f° r them will be acquired and vapid, 
sensational tales will not appeal to them. Stories of 
action, of heroic achievement, or of the lives of the 
humble furred and feathered" folk satisfy the crav- 
ings of the imagination and emotion, give food for 
thought, and are an educational force. 

If parents are willing to take these precautions 
to guard against temptation the girl or boy will very 
probably pass through the particularly dangerous 
years in safety, and with the resources of health and 



PROBLEMS OF PUBERTY 391 

education can face the later trials, but sometimes the ■ 
evil is a very real assailant and must be conquered in 
a hand-to-hand struggle. 

If the parents find that masturbation is being 
practiced by a child, a possibility' which must be 
recognized, the duty of a plain explanation becomes Faci the 
necessarv. Professor William Tames savs that the bad habit 

and calling 

danger of a person's continuing in a bad habit is that it by its 
he will not face it^ and call it by its name. That "hrchiid 
danger parents can eliminate, and they should never 
allow the child to be left in ignorance of the signifi- 
cance of such a practice and of its effects. 

If he knows that its mastery over a person entails 
a weakening of the will and the moral sense, a loss 
of vital force, and a consequent susceptibility to dis- Telling of 
ease, and an enfeebling of mental power, all of which quent 
grow more and more marked and more beyond his mental de- 
control as the habit becomes fixed, he can not fail to tenoratlon 
wish to make a fight against it. If he lacks confi- 
dence in the parent and can not be made to appre- 
ciate the gravity of the danger, there should be no 
hesitation in requiring him to receive advice from a 
physician. ' 

Occupation for the mind and hands is here again 
the cure as well as the prevention. Vigorous sports, 
life in the open air, a systematic direction of the mind 
away from self, and a determined seeking for social 
interests make possible a return to a healthy state 
of mind and body. 

Physiologically, parentage, or the exercise of the Evils of 
sexual function, before the aq-e of twentv-three at ear, y 

. ' parentage 

least, except in cases of precocious maturity, threatens 
health, and indeed life itself. 

We have spoken in another chapter of the gradual 
hardening or ossification of the bones in children. 



392 CARE OF CHILDREN. 

• The vertebrae, or small bones of the spine, are not 
completely ossified till after the sixteenth year. The 
two lower bones of the spinal column unite^ to close 
at the back the bony ring or girdle which we have 
called the pelvis. The construction of the pelvis, its 
shape and the position of the bones composing it have 
much to do w T ith the ease and safety of child-bearing. 
When we learn that these two vertebrae which form 
such an important part of the pelvic ring do not 
Argument begin their slow process of consolidation till the 
child- eighteenth year we can understand why late mar- 
riages are desirable. That fact is also a strong argu- 
ment against child-labor or any overtaxing of the 
strength in youth. 

MENSTRUATION 

In the girl the age of puberty is indicated, as has 
been said, by the periodic appearance of the men- 
strual flow. The term is a derivation from the Latin 
word menses, meaning month, and the reason for its 
use is obvious. 

It may be some months before menstruation is 
regularly established, but that need occasion no un- 
easiness. Persistent irregularity later, especially if 
accompanied by symptoms of disease, should not pass 
unnoticed, as it indicates at least a debilitated condi- 
tion. 

Vicarious menstruation is a periodic discharge of 
blood from some other organ or part of the body, 
Forms of which takes the place of menstruation. It may come 
from the nose or mouth, from the blood-vessels about 
the rectum, from the skin, or other parts of the body. 
It means a serious state of the system, not necessarily 
alarming if treatment is given in time. Tonics and es- 
pecially nourishing food are the requirements, and with 



vicarious 
menstrua- 
tion 



PROBLEMS OF PUBERTY 393 

the return of health, the normal functions will be re- 
sumed. 

The most hygienic napkin to use at this time is the 
cheesecloth, and absorbent cotton pad, which is burned 
after use. These can be bought at any druggist's, or 
at the large department stores, but the packages are 
very expensive and often are not as satisfactory as Ma king the 
those made at home. They will generally be large napkin 
enough if they are made nine inches long and three 
wide, and may be sewed at the edges or the absorbent 
cotton may be sewed or pinned with safety-pins on 
the- cheesecloth, which is then folded to the desired 
size. They can be made as thick as necessary. 

If for any reason these can not be used, a dozen 
squares of the cotton or linen diaper will be needed. 
If preferred, thin Canton flannel can be substituted. 
The supporter may be a fitted girdle, which can be 
bought ready made, a ribbon, or a straight loose belt 
of elastic tape. 

\Yith some women there is no feeling of discom- 
fort during this period, but- commonly there is a degree 
of backache, headache, weariness, and depression of sy m P toms 
spirits. Nervousness at this time may be very marked, 
r but as a rule the more normal a girl is in her health, 
the less she will suffer. The pain is commonly less 
after the flowing has fairly begun. 

During the establishment of this periodic sickness, 
great care should be exercised to protect the girl from 
cold, and to give both body and mind a rest from work g^mus^ 
of any sort. After she is older, and the menses are exercise 
appearing with regularity, the need for entire rest will 
depend on the amount of discomfort she feels. 

Exposure and undue exertion she should always 
avoid, and she should never take the violent exercise 
of tennis, dancing, or horseback riding at this time. 



394 CARE OF CHILDREN 

If she has much active pain, she' will be more com- 
simpie f ortable in bed. A hot drink and a hot-water bag gen- 
erally give relief, but when there are decided cramps, 
flannels wrung out of hot water and alcohol and ap- 
plied well down over the pubis will act as a sedative. 

The practice of taking narcotics is very unwise. 
One speedily grows to be a coward where pain is con- 
Avoid ail cerned, and the knowledge that relief is so easily ob- 
spirfts an tained constitutes the subtle power of the drug habit. 
The morphine preparations are dangerous for this rea- 
son, and most of the other effective anodynes have an 
injurious action upon the heart. 

It is much safer to use the local applications, and 
if the pain persists and returns each month to consult 
a physician who may discover a simple cause which 
he can remove by medication. 

If the flowing is delayed past the usual time, it may 

sometimes be brought on by soaking the feet in hot 

hot e foo e t-° f w ater > or by taking a full hot bath, a mild laxative, and 

bath a hot drink, just before going to bed. If there are 

no uncomfortable feelings,, and the health seems good, 

it is as well to wait for Nature to take her course. 

BATHING DURING MENSTRUATION 
. ., L The use of the tub bath is, of course, forbidden 

Avoid tub 

bath during menstruation, and a cold sponge is not wise, 

even if it is one's daily habit. 

Cleanliness at this time is as essential as at any 
other, and there is no reason why sponging in warm 
water should be attended by any unpleasant results. 
It is, perhaps, better not to put the feet into the water, 
and if the susceptibility to cold is increased at this time 
a little extra care should be taken to keep the feet warm 
during the bath, and the body shielded from draughts, 
and not exposed too long to the air. Local bathing 



Use rather 
a warm 
sponge 



PROBLEMS OF PUBERTY 895 

every day is very necessary, and there need be no 
hesitation or fear of injury to the health in the external 
use of water at this time. 

The habit, unfortunately growing more common, of 
using the internal douche each month at the end of Avoid the 

° douche 

this period is a very unwise practice, as well as being 
wholly uncalled for. 



MAY 22 1905 



